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Adverse Events in the Operating Room: Definitions, Prevalence, and Characteristics. A Systematic Review

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Abstract

Background

Adverse events occur commonly in the operating room (OR) and often contribute to morbidity, mortality, and increased healthcare spending. Validated frameworks to measure and report postoperative outcomes have long existed to facilitate exchanges of structured information pertaining to postoperative complication rates in order to improve patient safety. However, systematic evidence regarding measurement and reporting of intraoperative adverse events (iAE) is still lacking.

Methods

We searched Ovid Medline, Embase, and Cochrane databases for articles published up to June 2016 that measured and reported iAE. We presented the terms and definitions used to describe iAE. We identified the types of reported iAE and summarized them into discrete categories. We reported frequencies of iAE by detection methods.

Results

Of the 47 included studies, 30 were cross-sectional, 14 were case-series, and 3 were cohort studies. The studies used 16 different terms and 22 unique definitions to describe 74 types of iAE. Frequencies of iAE appeared to vary depending on the detection methods, with higher numbers reported when direct observation in the OR was used to detect iAE. Twenty studies assessed severity of iAE, which were mostly based on whether they resulted in postoperative outcomes.

Conclusions

This study systematically reviewed the current evidence on prevalence and characteristics of iAE that were detected by direct observation, reviews of patient charts, administrative data and incident reports, and surveys and interviews of healthcare providers. Our findings suggest that direct observation method has the most potential to identify and characterize iAE in detail.

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Authors and Affiliations

  1. International Centre for Surgical Safety, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria Street, 8th Floor East, Toronto, ON, M5B 1T8, Canada

    James J. Jung, Jonah Elfassy & Teodor Grantcharov

  2. Department of Surgery, University of Toronto, Toronto, ON, Canada

    James J. Jung & Teodor Grantcharov

  3. Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada

    James J. Jung, Peter Jüni & Teodor Grantcharov

  4. Applied Health Research Centre, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON, Canada

    Peter Jüni

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  1. James J. Jung
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Correspondence to James J. Jung.

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Jung, J.J., Elfassy, J., Jüni, P. et al. Adverse Events in the Operating Room: Definitions, Prevalence, and Characteristics. A Systematic Review. World J Surg 43, 2379–2392 (2019). https://doi.org/10.1007/s00268-019-05048-1

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