The Nature and Severity of Adverse Events in Select Outpatient Surgical Procedures in the Veterans Health Administration.
The Nature and Severity of Adverse Events in Select Outpatient Surgical Procedures in the Veterans Health Administration.
复制标题
退伍军人健康管理局部分门诊手术中不良事件的性质和严重程度。
DOI：
10.1097/qmh.0000000000000177
复制
发表时间：
2018
影响因子：
1.2
通讯作者：
Rosen,AmyK
中科院分区：
文献类型：
--
作者：
Mull,HillaryJ;Itani,KamalMF;Charns,MartinP;Pizer,StevenD;Rivard,PeterE;Hawn,MaryT;Rosen,AmyK
背景：关于门诊手术不良事件(AEs)的研究有限。作为退伍军人健康管理局(VA)AE监测项目的一部分，我们对选定的门诊手术病例进行图表回顾，以表征AE的性质和严重程度。方法：我们提取2012-2015财政年度VA门诊手术病例，根据术后卫生保健利用情况，选择高可能性(n=1185)和低可能性(n=1072)的AE。结果：我们在608例高可能性(51%)和126例低可能性(12%)的门诊外科手术中发现了不良反应。在1010个独特的AEs中，最常见的是伤口问题(n=261，26%)、尿潴留(23%)和尿路感染(12%)。虽然63%的急性呼吸综合征涉及轻微伤害，28%需要住院治疗，9%的急性呼吸综合征危害严重，包括8例需要干预以维持生命的急性呼吸综合征和2例死亡。总体而言，102例急性脑血管事件(10%)至少需要再次手术才能治疗。结论：在根据急性脑血管意外的可能性选择的VA门诊外科手术中，近40%的已确定事件对患者的伤害超过最小限度，这削弱了门诊手术相对安全的说法。常见和可预防的不良反应，如伤口裂开和尿潴留，可能是提高质量的有用目标。
Background:Research on adverse events (AEs) in outpatient surgery has been limited. As part of a Veterans Health Administration (VA) project on AE surveillance, we chart-reviewed selected outpatient surgical cases to characterize the nature and severity of AEs.Methods:We abstracted financial year 2012-2015 VA outpatient surgery cases selected with high (n= 1185) and low (n= 1072) likelihood of an AE based on postoperative health care utilization. The abstraction tool included established AE definitions and validated harm and severity scales.Results:We found AEs in 608 high-likelihood (51%) and 126 low-likelihood outpatient surgical procedures (12%). Among 1010 unique AEs, the most common were wound issues (n= 261, 26%), urinary retention (23%), and urinary tract infections (12%). While 63% of all AEs involved minimal harm, 28% required hospitalization, and 9% were severely harmful including 8 AEs requiring intervention to sustain life and 2 deaths. Overall, 102 AEs (10%) required, at minimum, a repeat surgery to treat.Conclusions:Among VA outpatient surgical procedures selected based on likelihood of an AE, nearly 40% of identified events carried more than minimal patient harm, undermining the claim that outpatient surgery is relatively safe. Prevalent and preventable AEs such as wound dehiscence and urinary retention may be useful targets for quality improvement.