Prevalência e evitabilidade de eventos adversos cirúrgicos em hospital de ensino do Brasil

Abstract

Objective to estimate the prevalence and avoidability of surgical adverse events in a teaching hospital and to classify the events according to the type of incident and degree of damage.Method cross-sectional retrospective study carried out in two phases. In phase I, nurses performed a retrospective review on a simple randomized sample of 192 records of adult patients using the Canadian Adverse Events Study form for case tracking. Phase II aimed at confirming the adverse event by an expert committee composed of physicians and nurses. Data were analyzed by univariate descriptive statistics.Results the prevalence of surgical adverse events was 21.8%. In 52.4% of the cases, detection occurred on outpatient return. Of the 60 cases analyzed, 90% (n = 54) were preventable and more than two thirds resulted in mild to moderate damage. Surgical technical failures contributed in approximately 40% of the cases. There was a prevalence of the infection category associated with health care (50%, n = 30). Adverse events were mostly related to surgical site infection (30%, n = 18), suture dehiscence (16.7%, n = 10) and hematoma/seroma (15%, n = 9).Conclusion the prevalence and avoidability of surgical adverse events are challenges faced by hospital management.

Implementation and Performance of Trackers for the Detection of Surgical Adverse Events

“…The frequency of each tracker found in the primary phase can also be conditioned by the completeness of the notes/records, aggravated by the institutional use of physical records, which contributes to underestimate the detection of the pAEs. 25 These factors partially explain the eight trackers that were not found in this study, such as neurological alteration absent at admission but present at the time of hospital discharge, as well as the doubling of the patient's creatinine level during hospitalization. These trackers require continuous registration and access to complementary examinations in which, many times, this information was not obtained and/or it was not possible to identify them attached in the medical records analyzed.…”

Eventos adversos cirúrgicos divulgados na mídia audiovisual: um estudo documental

“…2 In Brazil, there is a scarcity of studies that address the occurrence of adverse surgical events at the national level, since the existing ones portray only the local-regional reality. 3,4 The underreporting of these incidents by hospitals occurs because they have to deal with the exposure of flaws and weaknesses in the health care system and processes, which can contribute to the fact that these data are not sufficiently addressed in the available scientific publications. 5 In order to mitigate adverse surgical events and improve surgical patient safety, since 2009, the WHO recommends incorporating the Surgical Safety Checklist (SSC) in the operating room.…”

Relação da ocorrência de eventos adversos com o período perioperatório e fatores de risco: estudo quantitativo / The relation between the occurrence of adverse events of perioperative and risk factors: a quantitative study

“…Diversos estudos vêm abordando a ocorrência, os desfechos e a importância da identificação desses EA em pacientes cirúrgicos 7,[9][10][11][12] . Outros abordam o grau de dependência desses pacientes [13][14] , e relacionam os EA e o dimensionamento de enfermagem 8 .…”

“…Estes estudos mostram que a ocorrência de EA nos pacientes em condição cirúrgica de saúde é elevada, mas não abordam a relação do período operatório com a ocorrência dos EA, a contextualização com a complexidade do paciente cirúrgico e a relação com os fatores que podem influenciar a ocorrência dos EA [8][9][10][11]13 . Um dos estudos aponta que em 60 casos analisados, 90% (n=54) os EA eram evitáveis e mais de dois terços resultaram em danos leves a moderados 12 .…”

“…Dentre os EA que mais acometem os pacientes no pós-operatório estão os relacionados a infecção de sítio cirúrgico, deiscência de sutura, hematoma/seroma, lesão de órgãos digestórios, lesão vascular, choque hemorrágico, perda de acesso venoso, infecção do acesso venoso e queda [8][9]12 .…”