Objectives To estimate the frequency, severity, and preventability of adverse events associated with perioperative care, and to describe the setting and professions concerned. Design Multicenter retrospective cohort study. Setting 11 US hospitals. Participants 1009 patients from a randomly selected sample of 64 121 adults admitted for surgery during 2018. Main outcome measures Adverse events during inpatient perioperative care were assessed using a trigger method, identifying information previously associated with similar events, and from a comprehensive review of electronic health records. Trained nurses reviewed all records and flagged admissions with possible adverse events, which were then adjudicated by physicians, who confirmed the occurrence and characteristics of the events. Adverse events were classified as major if they resulted in serious harm requiring substantial intervention or prolonged recovery, involved a life threatening event, or led to a fatal outcome. Potentially preventable events included those definitively, probably, or possibly preventable. Results Among 1009 patients reviewed, adverse events were identified in 38.0% (95% confidence interval 32.6 to 43.4), with major adverse events occurring in 15.9% (12.7 to 19.0). Of 593 identified adverse events, 353 (59.5%) were potentially preventable and 123 (20.7%) were definitely or probably preventable. The most common adverse events were related to surgical procedures (n=292, 49.3%), followed by adverse drug events (n=158, 26.6%), healthcare associated infections (n=74, 12.4%), patient care events (n=66, 11.2%), and blood transfusion reactions (n=3, 0.5%). Adverse events were most frequent in general care units (n=289, 48.8%), followed by operating rooms (n=155, 26.1%), intensive care units (n=77, 13.0%), recovery rooms (n=20, 3.3%), emergency departments (n=11, 1.8%), and other in-hospital locations (n=42, 7.0%). Professions most involved were attending physicians (n=531, 89.5%), followed by nurses (n=349, 58.9%), residents (n=294, 49.5%), advanced level practitioners (n=169, 28.5%), and fellows (n=68, 11.5%). Conclusions Adverse events were identified in more than one third of patients admitted to hospital for surgery, with nearly half of the events classified as major and most potentially preventable. These findings emphasize the critical need for ongoing improvement in patient safety, involving all health professionals, throughout perioperative care. Supplementary method S3 shows the SAS code for data preparation and analysis. Owing to confidentiality requirements, the data for this project are primarily reserved for the immediate research team at Mass General Brigham. However, deidentified data can be accessed on secured servers by contacting the principal investigator (DWB). Additionally, the protocol and adverse events chart review training manual used for the project, along with further details about data management and analysis, are available to interested researchers.

中文翻译：

---

外科环境中住院护理的安全性：队列研究


目的 估计与围手术期护理相关的不良事件的频率、严重程度和可预防性，并描述相关的环境和专业。设计 多中心回顾性队列研究。设置 11 家美国医院。参与者 1009 年随机选择的 64 121 名成人样本中的 2018 名患者。主要结局指标 使用触发方法评估住院围手术期护理期间的不良事件，确定先前与类似事件相关的信息，并对电子健康记录进行全面审查。训练有素的护士审查了所有记录并标记了可能的不良事件入院，然后由医生做出裁决，确认事件的发生和特征。如果不良事件导致需要大量干预或延长恢复的严重伤害、涉及危及生命的事件或导致致命结局，则它们被归类为严重不良事件。潜在可预防的事件包括那些明确、可能或可能可以预防的事件。结果 在接受审查的 1009 例患者中，38.0% （95% 置信区间 32.6 至 43.4） 发现不良事件，主要不良事件发生率为 15.9% （12.7 至 19.0）。在确定的 593 例不良事件中，353 例 （59.5%） 是潜在可预防的，123 例 （20.7%） 是绝对或可能可预防的。最常见的不良事件与外科手术有关 （n=292， 49.3%），其次是药物不良事件 （n=158， 26.6%）、医疗保健相关感染 （n=74， 12.4%）、患者护理事件 （n=66， 11.2%） 和输血反应 （n=3， 0.5%）。不良事件在普通护理病房 （n=289， 48.8%） 最常见，其次是手术室 （n=155， 26.1%）、重症监护病房 （n=77， 13.0%）、恢复室 （n=20， 3.3%）、急诊科 （n=11， 1.8%） 和其他院内位置 （n=42， 7.0%）。参与最多的职业是主治医师 （n=531， 89.5%），其次是护士 （n=349， 58.9%）、住院医师 （n=294， 49.5%）、高级从业者 （n=169， 28.5%） 和研究员 （n=68， 11.5%）。结论 在超过 1/3 的住院手术患者中发现了不良事件，其中近一半的事件被归类为主要和最有可能预防的事件。这些发现强调了在整个围手术期护理过程中，所有卫生专业人员都需要持续改进患者安全的迫切需要。补充方法 S3 显示了用于数据准备和分析的 SAS 代码。由于保密要求，该项目的数据主要保留给麻省总医院的直接研究团队。但是，可以通过联系首席研究员 （DWB） 在安全服务器上访问去标识化数据。此外，感兴趣的研究人员可以使用该项目使用的方案和不良事件图表审查培训手册，以及有关数据管理和分析的更多详细信息。