Evaluation of Surgical Complications in a University Hospital: A Novel Root Cause Analysis Classification

Abstract

Objective: To analyze general surgery morbidity and mortality in King Chulalongkorn Memorial Hospital to identify the preventability and root causes of the complications using a novel root cause analysis (RCA) classification according to the period that the corrective action could have been introduced to prevent the complications. Materials and Methods: The authors retrospectively reviewed the morbidity and mortality between October 2012 and October 2016. The data collection included diagnostic groups, organ systems, severity, preventability, and RCA of the complications. Functional outcomes of the patients were also obtained such as full recovery, residual functional impairment, and death. Results: Six hundred seventy-six surgical complications occurred out of 19,440 surgeries performed (3.47%) during the study period. The most common organ system involved was gastrointestinal system (42.8%), followed by wound complications (18.9%). According to the Clavien-Dindo classification, the severity of the complications was 20.7% as grade 1, 18.9% as grade 2, 41.6% as grade 3, 3.7% as grade 4, and 15.1% as grade 5. The authors classified 27 complications as preventable (4.0%), 573 as potentially preventable (84.8%), and 76 as unpreventable (11.2%). RCA of the preventable and potentially preventable complications using the present RCA classification revealed that root causes were defect in the diagnoses (0.5%), defect in management decision making (5.0%), defect in preoperative management (6.1%), defect in intraoperative management (61.3%), and defect in postoperative management (27.0%). The most common defect in intraoperative management was inappropriate surgical approach or technique (58.7%). Most patients (80.2%) fully recovered from the complications, while 4.7% had residual functional impairment, and 15.1% died. Conclusion: The present study demonstrated that most complications in general surgery were preventable or potentially preventable. RCA showed that the most common root cause was the defect is intraoperative management, especially inappropriate surgical approach or technique. Keywords: Surgical complications; Root cause analysis; Morbidity and mortality conference