More than 1 in 3 surgical patients have complications, research shows, and many of these are the result of medical errors

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Despite decades of calls for greater attention to patient safety in hospitals, people undergoing surgery still have high rates of complications and medical errors, a new study shows.

More than a third of patients hospitalized for surgery have side effects related to their care, and at least 1 in 5 of these complications result from medical errors, the researchers found.

There are few studies of adverse events and medical errors in hospitals, and each study has slightly different methods, so the results are not always an apples-to-apples comparison. But the latest studypublished Thursday in the BMJ fits a pattern of evidence going back decades suggesting that hospitals have not made much progress on patient safety.

“It’s quite disturbing,” said Helen Haskell, an expert who became a reluctant advocate for patient safety after her son, Lewis Blackman, died at age 15 due to complications from surgery. to correct a condition called pectus excavatum, or sunken chest. She wrote an editorial team that was published alongside the new study.

A drug her son was given to control pain caused a hole in his digestive tract, called a perforated ulcer, leading to internal bleeding, infection and septic shock. Haskell says she watched her previously healthy, athletic son deteriorate before her eyes.

‘We couldn’t get anyone’s attention and he just died. He suffered for 30 hours and then died,” she said.

If he had survived, she said, he would be almost forty now, something that’s hard to think about.

After his death, Haskell founded the group Mothers Against Medical Error, which promotes patient safety in hospitals.

Haskell says it’s frustrating to see patients continue to suffer harm as a result of the care they receive in hospitals.

“These are long-standing issues that aren’t really being addressed well because I don’t think they’re as high in the consciousness of patients or healthcare providers as they should be,” she said.

For the new study, a team of researchers from Harvard University copied the careful methods of the Harvard Medical Practice Study. a study This study, conducted in the 1980s, was one of the first to map the harm to patients caused by healthcare. Its findings formed the basis for a 1999 report from the National Academies of Sciences titled “To Err is Human,” which raised the alarm about patient safety issues in healthcare.

“We’re trying to figure out: Have things changed? Have they gotten better?” said Dr. David Bates, professor of health policy and management at Harvard’s TH Chan School of Public Health, who led the new study.

Since the original study, there have been significant changes in hospitals designed to make surgeries safer. For example, electronic health records can send alerts if someone is prescribed two medications that could have dangerous interactions. Surgeons also routinely use pre-operative checklists, something that was not always done 40 years ago. There have also been campaigns to make doctors and patients aware of covert conditions such as sepsis, which can quickly kill.

However, the new research shows that safety concerns still exist.

“It is clear that the problem has not gone away. If anything, it’s even bigger than it was,” Bates said.

Bates says it’s difficult to directly compare the findings of the older Harvard study with the newer one because so much has changed in health care itself over the past four decades. For the older study, for example, the researchers combed through paper maps. This time they used electronic medical records.

Patients are also different. In many cases, people in hospitals are sicker than before, and procedures have become riskier and more complex, said Dr. Kedar Mate, president and CEO of the nonprofit Institute for Healthcare Improvement, an organization that advocates for patient safety.

Given this higher degree of difficulty, “the fact that our total number of adverse events is about the same as it was 20 years ago is in some ways an achievement, even if the risk of harm is still far too high and far too great.” said Mate, who was not involved in the new study.

Akin Demehin, senior director of quality and patient safety at the American Hospital Association, said hospitals and health care systems are continually working to promote patient safety and quality. Demehin pointed to it recent data from the U.S. Centers for Disease Control and Prevention that showed a decline in healthcare-associated infections.

The study looked at outcomes from more than 1,009 people admitted for surgery at 11 hospitals in Massachusetts in 2018.

The researchers say this was the most recent data they could have analyzed given how long it took for all hospitals to agree to participate (1½ years), collect all the data they needed (2 years), and have nurses review the data and identify potential side effects (1 year). Doctors then spent another four months verifying the events and assessing whether these problems appeared preventable, according to study researcher Dr. Antoine Duclos, who directs the Research on Healthcare Performance Lab at Claude Bernard University in Lyon, France.

Of the 1,009 surgical patients, 383 (38%) experienced at least one adverse event. About half of these events – 160 – were rated as serious or life-threatening, the study said.

More than 250 surgical patients, or about 1 in 4, had at least one adverse event that was considered potentially preventable, while 103, or about 10%, had events that were considered definitively preventable or the result of medical error. Based on the percentage of patients experiencing side effects, it was determined that approximately 60% were potentially preventable, and approximately 20% were definitively preventable.

The most common complications were related to the surgery itself, followed by medication errors and healthcare-related infections.

The risk of a complication increases with the patient’s age, the study found, and with the type of procedure they had. Surgeries involving the heart and lungs had the highest complication rate, followed by surgeries involving the intestines and digestive system, and procedures involving the bones and joints.

These incidents usually happened outside the operating room, usually after a patient returned to their hospital room. They include things like falls and pressure ulcers, Bates said.

Most hospitals have a policy of regularly reviewing cases where patients have been harmed with their doctors, but they do so for a small portion of the total, Bates added.

Bates said standard approaches to finding side effects only identify about 5% of cases.

“It’s just a much bigger problem than most hospitals realize,” he said.

Maat agrees. “It’s high, and it’s terrible, and it should be alarming to everyone in the industry and that means paying attention.”

The study has some important limitations. All participating hospitals were in Massachusetts, and although researchers attempted to include hospitals of different sizes in different parts of the state, it is not clear whether these results would be the same in other states or regions in the US.

The study authors also limited their focus to patients hospitalized for surgery. They may not apply to other settings, such as outpatient surgery centers, which typically perform less complex procedures.

The study also relied on electronic medical records, which are prone to errors, the researchers noted.

Still, advocates say the study should pay renewed attention to patient safety.

Bates says reducing surgical complications is a job for hospitals and doctors, but there are things patients can do to reduce the risk of complications.

“For example, it is useful to know which medications you are taking and to keep track of the dosages,” he says.

It’s also a good idea to take someone with you to the hospital if you need to have surgery.

“People who are in the hospital are often not as mentally alert,” Bates said. ‘They are not who they normally are and are not in pain. And so it can be very helpful to have someone else, a friend or a loved one.”