Adverse events after cancer surgery are up, but mortality is down

The national frequency of potentially avoidable adverse events after major oncologic surgery has increased substantially over the past decade, yet overall mortality rates have fallen.

An analysis of hospital-acquired adverse events following major cancer surgery performed on 2,508,917 persons aged 18 years and older at US hospitals between 1999 and 2009 showed that 324,852 patients (12.9%) experienced at least one Patient Safety Indicator (PSI) event as defined by the Agency for Healthcare Research and Quality (AHRQ). As Jesse D. Sammon, DO, of the Henry Ford Hospital in Detroit, Michigan, and fellow investigators explained in BMJ Open, PSIs include various preventable adverse events that have been shown to have reasonable accuracy and validity as indicators for enhancing quality and patient safety, such as blood clots, infections, respiratory failure, and pressure ulcers.

Sammon and colleagues determined that the frequency of PSI events following major cancer surgery has increased steadily over the past 10 years (estimated annual percentage change [EAPC]: 3.5%). In particular, postoperative sepsis, pressure ulcer, and respiratory failure rates increased substantially over the course of the years studied. However, significant advances were made in the prevention of anesthetic complications, hip fractures, and transfusion reactions in the perioperative period.

Compared with patients who had no or one PSI event, persons with one or more events had higher rates of in-hospital mortality, prolonged length of stay, and excessive hospital charges.

Patients at lower-volume hospitals experienced a higher frequency of potentially avoidable adverse events and higher failure-to-rescue rates. (Failure to rescue refers to the ability of a hospital to rescue patients effectively once complications occur.)

Interestingly, the rise in PSI events has been accompanied by a decrease in overall mortality (EAPC: -2.30%) and failure-to-rescue rates (EAPC: -3.01%).

“This paradox is explained in our report by the fact that physicians are probably getting increasingly better at identifying these adverse events early and managing them more effectively, thereby leading to lower mortality rates from adverse events and, by extension, lower overall mortality rates in the entire population of patients undergoing these procedures,” commented Sammon in a statement issued by Henry Ford Health System.

Nevertheless, concluded the study authors, policy changes must be made to improve the increasing burden of specific adverse events, such as postoperative sepsis, pressure ulcers, and respiratory failure.
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