Risk Factors and Epidemiology of Surgical Safety

  • Oliver Groene


Millions of people are admitted to hospitals every year; about one-third of admissions are for a surgical procedure; unfortunately, some patients experience adverse events, resulting in harm or even death. This chapter presents an overview on ways to define and classify harm, methods to assess the scale of harm, estimates of actual harm, solutions to prevent errors and harm in the perioperative area, and approaches to the surveillance and monitoring of surgical safety. It concludes that in order to support the improvement of quality and safety in surgery, a stronger focus on the upstream determinants of safety is needed.


Epidemiology Harm Retrospective case record review Administrative data Patient safety practices 


  1. 1.
    Baines R, Langelaan M, de Bruijne M, Spreeuwenberg P, Wagner C. How effective are patient safety initiatives? A retrospective patient record review study of changes to patient safety over time. BMJ Qual Saf. 2015;24(9):561–71. doi: 10.1136/bmjqs-2014-003702.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    World Health Organization. Safe Surgery Guidelines.
  3. 3.
    Hogan H, Healey F, Neale G, Thomson R, Vincent C, Black N. Preventable deaths due to problems in care in English acute hospitals: a retrospective case record review study. BMJ Qual Saf. 2012;21(9):737–45.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Barach, P., Small DS. Reporting and preventing medical mishaps: Lessons from non-medical near miss reporting systems. British Medical Journal 2000; 320:753–763.Google Scholar
  5. 5.
    Brown C, et al. General and specific interventions across the system and evaluation end points. Qual Saf Health Care. 2008;17:158–62.CrossRefPubMedGoogle Scholar
  6. 6.
    Lilford R, Chilton PJ, Hemming K, Brown C, Girling A, Barach P. Evaluating policy and service interventions: framework to guide selection and interpretation of study end points. BMJ. 2010;341:c4413.Google Scholar
  7. 7.
    Bickler SW, Sanno-Duanda B. Epidemiology of paediatric surgical admissions to a government referral hospital in the Gambia. Bull World Health Organ. 2000;78:1330–6.PubMedPubMedCentralGoogle Scholar
  8. 8.
    Weiser TG, Regenbogen SE, Thompson KD, Haynes AB, Lipsitz SR, Berry WR, Gawande AA. An estimation of the global volume of surgery: a modelling strategy based on available data. Lancet. 2008;372:139–44.CrossRefPubMedGoogle Scholar
  9. 9.
    Cassera MA, Zheng B, Martinec DV, Dunst CM, Swanström LL. Surgical time independently affected by surgical team size. Am J Surg. 2009;198(2):216–22. doi: 10.1016/j.amjsurg.2008.10.016.CrossRefPubMedGoogle Scholar
  10. 10.
    Ghaferi AA, Birkmeyer JD, Dimick JB. Hospital volume and failure to rescue with high-risk surgery. Med Care. 2011;49:1076–81.CrossRefPubMedGoogle Scholar
  11. 11.
    Cassin B, Barach P. Making Sense of Root Cause Analysis Investigations of Surgery-Related Adverse Events. Surg Clin North America 2012, 1–15, doi: 10.1016/j.suc.2011.12.008.
  12. 12.
    The National Reporting and Learning System (NRLS).
  13. 13.
    de Vries EN, Ramrattan MA, Smorenburg SM, Gouma DJ, Boermeester MA. The incidence and nature of in-hospital adverse events: a systematic review. Qual Saf Health Care. 2008;17(3):216–23.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
  15. 15.
    Reichman DE, Greenberg JA. Reducing surgical site infections: a review. Rev Obstet Gynecol. 2009;2(4):212–21.PubMedPubMedCentralGoogle Scholar
  16. 16.
    Seiden, S., Barach, P. Wrong-side, wrong procedure, and wrong patient adverse events: Are they preventable? Archives of Surgery, 2006;141:1–9.Google Scholar
  17. 17.
    Cima RR, Kollengode A, Garnatz J, et al. Incidence and characteristics of potential and actual retained foreign object events in surgical patients. J Am Coll Surg. 2008;207(1):80–7.CrossRefPubMedGoogle Scholar
  18. 18.
    Shojania KG, Duncan BW, McDonald KM, Wachter RM. A Critical Analysis of Patient Safety Practices. Evidence Report/Technology Assessment, No. 43. Report prepared for the Agency for Healthcare Research and Quality, Contract No. 290-97-0013. Prepared by: University of California at San Francisco (UCSF)-Stanford University Evidence-based Practice Center.
  19. 19.
    Shekelle PG, Wachter RM, Pronovost P et al. Making Health Care Safer II: An Updated Critical Analysis of the Evidence for Patient Safety Practices. Comparative Effectiveness Review No. 211. (Prepared by the Southern California-RAND Evidence-based Practice Center under Contract No.290-2007-10062-I.) AHRQ Publication No. 13-E001-EF. Rockville: Agency for Healthcare Research and Quality. March 2013.
  20. 20.
    Sanchez J, Barach P. High Reliability Organizations and Surgical Microsystems: Re-engineering Surgical Care. Surgical Clinics of North America, 02/2012; 92(1):1–14. DOI:  10.1016/j.suc.2011.12.005.
  21. 21.
    Taylor N, Clay-Williams R, Hogden E, Braithwaite J, Groene O. High performing hospitals: a qualitative systematic review of associated factors and practical strategies for improvement. BMC Health Serv Res. 2015;15:244.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Secanell M, Groene O, Arah OA, Lopez MA, Kutryba B, Pfaff H, Klazinga N, Wagner C, Kristensen S, Bartels PD, Garel P, Bruneau C, Escoval A, França M, Mora N, Suñol R, DUQuE Project Consortium. Deepening our understanding of quality improvement in Europe (DUQuE): overview of a study of hospital quality management in seven countries. Int J Qual Health Care. 2014;26 Suppl 1:5–15.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Sunol R, Wagner C, Arah OA, Kristensen S, Pfaff H, Klazinga N, Thompson CA, Wang A, DerSarkissian M, Bartels P, Michel P, Groene O, DUQuE Project Consortium. Implementation of departmental quality strategies is positively associated with clinical practice: results of a multicenter study in 73 hospitals in 7 European countries. PLoS One. 2015;10(11):e0141157.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Kringos DS, Sunol R, Wagner C, Mannion R, Michel P, Klazinga NS, Groene O, DUQuE Consortium. The influence of context on the effectiveness of hospital quality improvement strategies: a review of systematic reviews. BMC Health Serv Res. 2015;15:277.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Groene O, Kringos D, Sunol R for the DUQUE Consortium. Seven strategies to improve the quality and safety of hospitals.
  26. 26.
    Yao GL, Novielli N, Manaseki–Holland S, Chen FY, Klink van der M, Barach P, Chilton P, Lilford R. Evaluation of a predevelopment service delivery intervention: an application to improve clinical handovers. BMJ Qual Saf. 2012; 21(s1): i29–38.Google Scholar
  27. 27.
    Shojania KG, Thomas EJ. Trends in adverse events over time: why are we not improving? BMJ Qual Saf. 2013;22(4):273–7. doi: 10.1136/bmjqs-2013-001935.CrossRefPubMedGoogle Scholar
  28. 28.
    Sunol R, Wagner C, Arah OA, Shaw CD, Kristensen S, Thompson CA, Dersarkissian M, Bartels PD, Pfaff H, Secanell M, Mora N, Vlcek F, Kutaj-Wasikowska H, Kutryba B, Michel P, Groene O, DUQuE Project Consortium. Evidence-based organization and patient safety strategies in European hospitals. Int J Qual Health Care. 2014;26 Suppl 1:47–55.CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Taylor A, Neuburger J, Walker K, Cromwell D, Groene O. How is feedback from national clinical audits used? Views from English National Health Service trust audit leads. J Health Serv Res Policy. 2016;21(2):91–100.CrossRefPubMedGoogle Scholar
  30. 30.
    Barach, P; Pahl R, Butcher A. Actions and Not Words, Randwick, NSW: JBara Innovations for HQIP, National Health Service, London, 2013.Google Scholar
  31. 31.
    Bottle A, Aylin P. Application of AHRQ patient safety indicators to English hospital data. Qual Saf Health Care. 2009;18:303–8.CrossRefPubMedGoogle Scholar
  32. 32.
    Aylin P, Tanna S, Bottle A, Jarman B. How often are adverse events reported in English hospital statistics? BMJ. 2004;329(7462):369.CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Quan H, Drösler S, Sundararajan V, Wen E, Burnand B, Couris CM, Halfon P, Januel JM, Kelley E, Klazinga N, Luthi JC, et al. Adaptation of AHRQ patient safety indicators for use in ICD-10 administrative data by an International Consortium. In: Henriksen K, Battles JB, Keyes MA, Grady ML, editors. Advances in patient safety: new directions and alternative approaches, Assessment, vol. 1. Rockville: Agency for Healthcare Research and Quality; 2008.Google Scholar
  34. 34.
    Zhan C, Miller MR. Administrative data based patient safety research: a critical review. Qual Saf Health Care. 2003;21 Suppl 2:ii58–63.Google Scholar
  35. 35.
    Nolte E, Roland M, Guthrie S, Brereton L. Preventing emergency readmissions to hospital. A scoping review. Cambridge: RAND; 2012.Google Scholar
  36. 36.
    Fischer C, Lingsma H, Hardwick R, Cromwell DA, Steyerberg E, Groene O. Risk adjustment models for short-term outcomes after surgical resection for oesophagogastric cancer. Br J Surg. 2016;103(1):105–16.CrossRefPubMedGoogle Scholar
  37. 37.
    Barach P, Lipshultz S. The benefits and hazards of publicly reported quality outcomes. Progress in in Pediatric Cardiology (2016), pp. 45–49, DOI information:  10.1016/j.ppedcard.2016.06.001.
  38. 38.
    Walker K, Neuburger J, Groene O, Cromwell DA, van der Meulen J. Public reporting of surgeon outcomes: low numbers of procedures lead to false complacency. Lancet. 2013;382(9905):1674–7.CrossRefPubMedGoogle Scholar
  39. 39.
    Wagner C, Thompson CA, Arah OA, Groene O, Klazinga NS, Dersarkissian M, Suñol R, DUQuE Project Consortium. A checklist for patient safety rounds at the care pathway level. Int J Qual Health Care. 2014;26 Suppl 1:36–46.CrossRefPubMedPubMedCentralGoogle Scholar
  40. 40.
    Johnson, J and Barach, P. Quality Improvement Methods to Study and Improve the Process and Outcomes of Pediatric Cardiac Surgery. Progress in Pediatric Cardiology. 2011;32:147–153.Google Scholar

Copyright information

© Springer International Publishing Switzerland 2017

Authors and Affiliations

  1. 1.OptiMedis AGHamburgGermany
  2. 2.Department of Health Services Research and PolicyLondon School of Hygiene and Tropical MedicineLondonUK

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