What are the perioperative adverse events during surgery?

From the Guidelines

Perioperative adverse events during surgery can be minimized by implementing a comprehensive audit system and adhering to evidence-based guidelines, as supported by the most recent study 1 from 2020. The most critical aspect of reducing perioperative adverse events is to identify and address potential risks before, during, and after surgical procedures.

• Key areas to focus on include:
  • Surgical site infections
  • Unplanned returns to the operating room
  • Medication errors
  • Anesthesia complications
  • Wrong-site surgeries
  • Retained surgical items
  • Unexpected deaths According to the study 1, there is low-certainty evidence that antibacterial irrigation may reduce the incidence of surgical site infections, but the results should be interpreted with caution due to the risk of bias and heterogeneity among the included trials. The study 1 from 2014 highlights the importance of careful consideration when using perioperative beta blockade, as it may prevent perioperative myocardial infarction but is also associated with increased rates of death, stroke, hypotension, and bradycardia. I strongly recommend that healthcare facilities prioritize the implementation of a comprehensive audit system, as outlined in the example answer, to systematically track, analyze, and address perioperative adverse events, and to adhere to evidence-based guidelines to minimize risks and improve patient outcomes, as supported by the study 1. The study 1 from 2014 emphasizes the importance of pre-operative assessment in older people to enable risk-stratification and proactive identification of modifiable risk factors, which can improve the likelihood of a successful surgical outcome. The study 1 from 2007 provides recommendations for the perioperative use of pulmonary artery catheters, highlighting the need for careful consideration of the potential benefits and risks, and the importance of weighing the potential for harm against any potential benefit from the information obtained from the monitor.

From the FDA Drug Label

The prophylactic administration of Cefazolin for Injection, USP preoperatively, intraoperatively, and postoperatively may reduce the incidence of certain postoperative infections in patients undergoing surgical procedures which are classified as contaminated or potentially contaminated The prophylactic administration of Cefazolin for Injection, USP also may be effective in surgical patients in whom infection at the operative site would present a serious risk

The perioperative adverse events during surgery are not explicitly stated in the provided drug labels. However, the labels do mention the use of cefazolin as a prophylactic measure to reduce the incidence of postoperative infections in certain surgical procedures.

• Perioperative prophylaxis may reduce the incidence of certain postoperative infections.
• The labels do not provide information on specific adverse events during surgery. 2

From the Research

Perioperative Adverse Events

Perioperative adverse events are a significant concern in surgical care, with various studies highlighting their incidence and risk factors. Some of the key findings include:

• Adverse event rates are higher for in-patient than out-patient surgical procedures, with a rate of 2.11% vs. 1.45% 3
• The types of adverse events differ for in-patient and out-patient surgical procedures, with respiratory, drug error, cardiology, and neurology being the main adverse events in anesthesia 4
• Human errors, slips, and lapses are common causes of adverse events in anesthesia, resulting in damage to the patient, such as permanent injuries or death 4
• Care planning, efficient communication, and teamwork are critical to prevent adverse events in anesthesia 4

Risk Factors

Several risk factors have been identified as contributing to perioperative adverse events, including:

• ASA physical status (PS) 3
• Age 3
• Duration of anesthesia care 3
• Anesthesia type 3
• Medical staff assigned to the case 3
• Pre-existing comorbidities 5

Prevention and Management

To prevent and manage perioperative adverse events, various strategies can be employed, such as:

• Using clinical scores and/or biomarkers to identify patients at high risk of developing major adverse events 5
• Allocating high-risk patients to specific care pathways with peri-operative organ protection, close surveillance, and specific early interventions 5
• Implementing evidence-based perioperative patient safety practices, such as standardization and harmonization of perioperative care 6
• Conducting regular quality assurance audits and providing feedback to anaesthetic staff 7