International Journal for Quality in Health Care Advance Access originally published online on July 24, 2008
International Journal for Quality in Health Care 2008 20(6):406-411; doi:10.1093/intqhc/mzn032
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Predictors of adverse events in surgical admissions in Australia
1 Faculty of Health, University of Newcastle, Australia
2 Faculty of Medicine, University of New South Wales, Australia
Objective. The purpose of this study was to determine risk factors of adverse events in five surgical procedures.
Design. Retrospective record review was used to determine adverse events and risk factors of 1177 surgical admissions. Procedures included in this study were transurethral resection of prostate, hysterectomy, hip and knee arthroplasty, cholecystectomy and herniorrhaphy. Risk factors included comorbidity, lifestyle factors and medications. Stepwise multiple logistic regression was used to determine predictors of adverse events.
Setting. Two teaching hospitals in regional New South Wales, Australia.
Participants. 1177 surgical admissions for five high volume procedures.
Main outcome measures. Identified predictors of adverse events in surgical admissions.
Results. The adverse event rate was 23.1% for all procedures (range 17.5–33.7% for the five procedures). Two factors were strongly predictive of an adverse event in all surgical admissions: age >70 years [odds ratio (OR) 1.9, 95% confidence intervals (CI) 1.3–2.6] and duration of operation (P = 0.005). Other predictive factors were: contaminated surgical site (OR 2.1, 95% CI 1.2–3.7) and anaemia (OR 1.8, 95% CI 1.1–2.8). Predictive factors of individual procedures included: urine retention (transurethral resection of the prostate); extended duration of operation and asthma (hysterectomy); acute admissions and extended duration of operation (cholecystectomy); and warfarin type drugs, ethanol abuse, failed prostheses, GI ulcer/inflammation, rheumatoid arthritis, and ischaemic heart disease (hip and knee joint arthroplasty).
Conclusions. The results of this study suggest that five factors should be routinely monitored for patients undergoing these procedures: age >70 years, type of procedure, duration of operation >2 h, contaminated surgical site and anaemia.
Keywords: surgical procedures, elective, adverse events, predictors, risk factors
Address reprint requests to: Ashley Kable, Tel: +61-2-49216334, Fax: +61-2-49216301; E-mail: ashley.kable{at}newcastle.edu.au
Accepted for publication June 30, 2008.