PMID- 29944625
OWN - NLM
STAT- MEDLINE
DCOM- 20190610
LR  - 20210917
IS  - 1550-5154 (Electronic)
IS  - 1063-8628 (Print)
IS  - 1063-8628 (Linking)
VI  - 27
IP  - 3
DP  - 2018 Jul/Sep
TI  - The Nature and Severity of Adverse Events in Select Outpatient Surgical 
      Procedures in the Veterans Health Administration.
PG  - 136-144
LID - 10.1097/QMH.0000000000000177 [doi]
AB  - 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.
FAU - Mull, Hillary J
AU  - Mull HJ
AD  - Center for Healthcare Organization and Implementation Research (Drs Mull, Charns, 
      Rivard, and Rosen and Ms MacDonald) and Department of Surgery (Dr Itani), VA 
      Boston Healthcare System, Massachusetts; Department of Surgery, Boston University 
      School of Medicine, Massachusetts (Drs Mull, Itani, and Rosen); Harvard Medical 
      School, Boston, Massachusetts (Dr Itani); Department of Health Law, Policy and 
      Management, Boston University School of Public Health, Massachusetts (Drs Charns 
      and Pizer); Partnered Evidence-Based Policy Resource Center, Department of 
      Veterans Affairs, Boston, Massachusetts (Dr Pizer); Healthcare Administration, 
      Sawyer Business School Suffolk University, Boston, Massachusetts (Dr Rivard); and 
      Palo Alto VA Medical Center, and Stanford University School of Medicine, 
      California (Dr Hawn).
FAU - Itani, Kamal M F
AU  - Itani KMF
FAU - Charns, Martin P
AU  - Charns MP
FAU - Pizer, Steven D
AU  - Pizer SD
FAU - Rivard, Peter E
AU  - Rivard PE
FAU - Hawn, Mary T
AU  - Hawn MT
FAU - Rosen, Amy K
AU  - Rosen AK
LA  - eng
GR  - IK2 HX001520/HX/HSRD VA/United States
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PT  - Research Support, U.S. Gov't, Non-P.H.S.
PL  - United States
TA  - Qual Manag Health Care
JT  - Quality management in health care
JID - 9306156
MH  - Ambulatory Surgical Procedures/*adverse effects/statistics & numerical data
MH  - Female
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Postoperative Complications/epidemiology/etiology
MH  - Severity of Illness Index
MH  - United States
MH  - United States Department of Veterans Affairs/*statistics & numerical data
PMC - PMC8445237
MID - NIHMS1739453
EDAT- 2018/06/27 06:00
MHDA- 2019/06/14 06:00
PMCR- 2021/09/16
CRDT- 2018/06/27 06:00
PHST- 2018/06/27 06:00 [entrez]
PHST- 2018/06/27 06:00 [pubmed]
PHST- 2019/06/14 06:00 [medline]
PHST- 2021/09/16 00:00 [pmc-release]
AID - 00019514-201807000-00005 [pii]
AID - 10.1097/QMH.0000000000000177 [doi]
PST - ppublish
SO  - Qual Manag Health Care. 2018 Jul/Sep;27(3):136-144. doi: 
      10.1097/QMH.0000000000000177.