Opening Pandora's box: Understanding the nature, patterns, and 30-day outcomes of intraoperative adverse events

Michael N. Mavros, George C. Velmahos, Andreas Larentzakis, Daniel Dante Yeh, Peter Fagenholz, Marc De Moya, David R. King, Jarone Lee, Haytham M.A. Kaafarani

Research output: Contribution to journalArticlepeer-review

18 Scopus citations

Abstract

Background Little evidence exists regarding the characteristics of intraoperative adverse events (iAEs)

Methods: Administrative data, the American College of Surgeons - National Surgical Quality Improvement Project, and systematic review of operative reports were used to confirm iAEs in abdominal surgery patients. Standard American College of Surgeons - National Surgical Quality Improvement Project data were supplemented with variables including injury type/organ, phase of operation, adhesions, repair type, and intraoperative consultations

Results: Two hundred twenty-seven iAEs (187 patients) were confirmed in 9,292 patients. Most common injuries were enterotomies during intestinal surgery (68%) and vessel injuries during hepatopancreaticobiliary surgery (61%); 108 iAEs (48%) specifically occurred during adhesiolysis. A third of the iAEs required organ/tissue resection or complex reconstruction. Because of iAEs, 20 intraoperative consults (11%) were requested and 9 of the 66 (16%) laparoscopic cases were converted to open. Thirty-day mortality and morbidity were 6% and 58%, respectively. The complications included perioperative transfusions (36%), surgical site infection (19%), systemic sepsis (13%), and failure to wean off the ventilator (12%)

Conclusions: iAEs commonly occur in reoperative cases requiring lysis of adhesions and possibly lead to increased patient morbidity. Understanding iAEs is essential to prevent their occurrence and mitigate their adverse effects.

Original languageEnglish (US)
Pages (from-to)626-631
Number of pages6
JournalAmerican journal of surgery
Volume208
Issue number4
DOIs
StatePublished - Oct 1 2014
Externally publishedYes

Keywords

  • Accidental puncture or laceration
  • Intraoperative adverse event
  • Outcomes

ASJC Scopus subject areas

  • Surgery

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