One in four neurosurgery patients experience adverse events, of which 25% are attributable to human error, according to a study published in Brain and Spine.
“Adverse events in surgery are a relevant cause of economic costs, disability and death,” Hanno S. Meyer, of the department of neurosurgery at Technical University of Munich School of Medicine, and colleagues wrote. “In neurosurgery, there is ample potential for [adverse events] that are cost-intensive and cause severe patient harm, such as unplanned returns to the operating room or postoperative long-term neurologic deficits.”
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As little is known regarding the frequency of adverse events and contribution of human error in neurosurgery, Meyer and colleagues sought to investigate the incidence, nature and severity of both.
They conducted a prospective, observational study, which included 4,176 patients who underwent neurosurgery (2,258 cranial neurosurgery cases and 1,918 spinal neurosurgery cases) at a tertiary care academic hospital between September 2019 and September 2020. Adverse events, which were classified in line with the American College of Surgeons National Surgical Quality Improvement Program 30-day outcome complication definition (ACS-NSQUIP) and graded on a scale of 1 to 6 according to the Spine Adverse Events Severity System (SAVES-V2), were recorded daily and evaluated weekly by the department’s senior neurosurgeons. Incidence of human error was categorized as preoperative, intraoperative or postoperative.
Results showed that 25% of patients experienced at least one adverse event, and 25.9% of those events were associated with human error, particularly in execution (18.3%) or planning (5.6%) deficiencies. Researchers also found that 48.8% of cases had severe adverse events that were graded at least 3 on the SAVES-V2 scale, and patients with multiple adverse events (8.6%) experienced more severe events (67.6%). In addition, adverse events were more severe in cranial neurosurgery (57.6%) compared with spinal neurosurgery (39.4%).
“Prospective data on the incidence of all types of [adverse events] in neurosurgery bears significance not only for the education of our patients but also for the discussion of quality-based accreditation and reimbursement systems in upcoming health reforms,” Meyer and colleagues wrote.
