Medical Errors and Complications in Neurointervention: Under-reported and Under-estimated? A systematic review

BACKGROUND AND PURPOSE: Medical errors and complications (MEAC) in neurointervention have significant implications for patient safety and healthcare costs, with 50% of patient harm due to medical errors being preventable. Despite this, literature on MEAC in the outpatient setting is scarce. METHODS: We conducted a systematic review of PubMed/Medline in adherence to PRISMA guidelines and identified studies on neurointerventional complications published from 2004 to 2024. Eligible studies were original research articles that reported on medical errors or complications, stratified by care phase: pre-hospital, in-hospital non-procedural, procedural, and post-discharge. Data extraction included demographic characteristics, time points, types of errors and complications, follow-up methods, and reporting practices. Descriptive statistics and unadjusted logistic regression were used to analyze the data. RESULTS: From 174 studies involving 60,812 patients, we observed a total complication rate of 17.2%. Most studies reported on in-hospital procedural complications in their data (83.3%), while only 1.7% and 31.6% addressed pre-hospital and post-discharge complications, respectively. Systematic patient follow-up significantly increased the likelihood of identifying post-discharge complications (OR 2.16, 95% CI 1.06–4.40). Severe adverse events dominated post-discharge reports, highlighting a possible gap in documenting minor complications and medical errors, particularly in outpatient settings. CONCLUSION: Neurointerventional literature primarily focuses on in-hospital, procedure-related events, while only few studies on pre-hospital and post-discharge errors and complications are available. Standardized tools, such as patient-reported outcome measures, and rigorous follow-up protocols are critical for comprehensive complication reporting. Establishing quality standards for complication documentation would facilitate improved patient care and enable systematic comparisons across studies.