D. Ali1, R. Durrani2, A. Khan1 1Vanderbilt University Medical Center, Section Of Surgical Sciences, Nashville, TN, USA 2Aga Khan University Medical College, Centre For Innovation In Medical Education, Karachi, Sindh, Pakistan
Introduction: Despite constant initiatives to improve surgical quality and perioperative patient safety, unintentional errors during surgical procedures remain a significant cause of patient morbidity and mortality. Nationwide data on death from surgical errors in the United States remain unexplored. This study aimed to describe and contextualize the trends of mortality from surgical errors over the past two decades.
Methods: The Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) database was used to extract and analyze death certificates from January 1999 to December 2020 for deaths due to errors in surgical and endoscopic procedures. Records were extracted for patients 25 years or older, using International Statistical Classification of Diseases Tenth Revision version 10 codes Y60.0, Y60.4, Y61.0, Y61.4, Y62.0, Y62.4, Y65.2, Y65.4, and Y65.5. Data was abstracted for demographics, urban-rural classification, and geographic details. Crude death rates (CDRs) per 1,000,000 persons were calculated, and the Joinpoint Regression Program (Joinpoint V 4.9.0.0 National Cancer Institute) was used to determine the annual percentage changes (APC) in CDRs.
Results: Between 1999 and 2020, a total of 4,144 deaths occurred from surgical errors among patients aged ≥25 in the United States, leading to an overall CDR of 0.93. CDR due to errors increased from 1.1 in 1999 to 1.3 in 2014 with an APC of 10.45, followed by a period of downward trend towards 0.6 in 2020 with an APC of -4.18 (Figure 1a). Geographical differences were noted; the most prominent change in CDRs was seen in large urban areas where the APC was +6.8 from 1999 to 2007, followed by a downward trend with an APC of -5.7 from 2007 to 2020 (Figure 1b). Trends for medium urban and rural areas could not be tracked since the data was unreliable owing to less than 9 deaths (the CDC masks such a finding to protect patient identity). White and African American races had the highest (0.98) and second highest (0.95) CDRs respectively; whereas, the Asian race had the lowest CDR (0.51) (Figure 1c). CDR was higher for women throughout the study period though it followed a similar downward trend for both men and women (Figure 1d).
Conclusion: Mortality in adult patients from surgical errors has halved between 1999 and 2020. This re-emphasizes the importance of quality control measures introduced over the years. The positive trends have been undermined by disparities in surgical errors related to CDR between patients based on city metropolitan status, race, and sex, serving as areas ripe for targeted interventions.