Abstract
Background: Surgical complications are associated with a significant burden to patients and hospitals and are increasingly discussed in recent literature. This cohort study reviewed surgery-related complications in a Level I trauma center. The effect of a complication avoidance care bundle on the rate of surgical complications was analyzed. Methods: All complications (surgical and nonsurgical) that occur in our trauma department are prospectively captured using a standardized documentation form and are discussed and analyzed in a weekly trauma Morbidity and Mortality (M&M) conference. Surgical complication rates are calculated using the annual surgical procedure numbers. Based on discussions in the M&M conference, a complication avoidance care bundle consisting of five measures was established: (1) Improving team situational awareness; (2) reducing operating room traffic by staff members and limiting door-opening events; (3) preoperative screening for infectious foci; (4) adapted preoperative antibiotic prophylaxis in anatomic regions with a high risk of infectious complications; and (5) use of iodine-impregnated adhesive drape. Results: The number of surgical procedures steadily increased over the study years, from 3587 in 2015 to 3962 in 2019 (an increase of 10.5%). Within this 5-year study period, the overall rate of surgical complications was 0.8%. Surgical site infections were the most frequently found complications (n = 40, 24.8% of all surgical complications), followed by screw malposition (n = 20, 12.4%), postoperative dislocations of arthroplasties (n = 18, 11.2%), and suboptimal fracture reduction (n = 18, 11.2%). Following implementation of the complication avoidance care bundle, the overall rate of surgical complications significantly decreased, from 1.14% in the year 2016 to 0.56% in the study year 2019, which represents a reduction of 51% within a 3-year time period. Conclusions: A multimodal strategy targeted at reducing the surgical complication rate can be successfully established based on a transparent discussion of adverse surgical outcomes. The combination of the different preventive measures was associated with reducing the overall complication rate by half within a 3-year time period.
Highlights
Complications following surgical procedures have received increasing attention in recent years
A total of 16,349 patients were admitted to our department and underwent surgical procedures (Table 1)
The numbers of surgical procedures steadily increased over the study years, from 3587 in 2015 to 3962 in 2019 (Figure 1)
Summary
Complications following surgical procedures have received increasing attention in recent years. A number of surgical checklists have been developed and, most importantly, protocols to prevent “wrong site, wrong procedure, and wrong person” surgery [4,5,6,7,8] These checklists include different components: a pre-procedure verification process, in which the entire team ensures that all relevant documents, information, and equipment are available; marking the operative site; and performing a “time out” before the procedure [9]. Surgical complications are associated with a significant burden to patients and hospitals and are increasingly discussed in recent literature This cohort study reviewed surgery-related complications in a Level I trauma center. The combination of the different preventive measures was associated with reducing the overall complication rate by half within a 3-year time period
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