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Inicio Cirugía Española (English Edition) Continuous monitoring of adverse effects improves surgical outcomes
Journal Information
Vol. 102. Issue 4.
Pages 209-215 (April 2024)
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Vol. 102. Issue 4.
Pages 209-215 (April 2024)
Original article
Continuous monitoring of adverse effects improves surgical outcomes
El registro continuado de los efectos adversos mejora de los resultados quirúrgicos
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Luis Grandea,b,c,1,
Corresponding author
luis.grande@uab.cat

Corresponding author.
, Marta Gimenoa,b,1, Jaime Jimenoa,d, Manuel Peraa,b,c,1, Joan Sancho-Insensera,b,c, Miguel Peraa,b,e
a Servicio de Cirugía General, Hospital del Mar, Barcelona, Spain
b Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, Spain
c Departmento de Cirugía, Universitat Autònoma de Barcelona, Bellaterra (Barcelona), Spain
d Servicio de Cirugía General, Hospital Universitario Marqués de Valdecilla, Santander, Spain
e Departmento de Medicina y Ciencias de la Salud (MELIS), Universitat Pompeu Fabra, Barcelona, Spain
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Tables (2)
Table 1. Historical evolution of the main results during the period analysed (2003–2022).
Table 2. The 16 most frequent adverse effects among the total of 24846 entered.
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Abstract
Background

There has been significant debate about the advantages and disadvantages of using administrative databases or clinical registry in healthcare improvement programs. The aim of this study was to review the implementation and outcomes of an accountability policy through a registry maintained by professionals of the surgical department.

Materials and methods

All patients admitted to the department between 2003 and 2022 were prospectively included. All adverse events (AEs) occurring during the admission, convalescent care in facilities, or at home for a minimum period of 30 days after discharge were recorded.

Results

Out of 60,125 records, 24,846 AEs were documented in 16,802 cases (27.9%). There was a progressive increase in the number of AEs recorded per admission (1.17 in 2003 vs. 1.93 in 2022) with a 26% decrease in entries with AEs (from 35.0% in 2003 to 25.8% in 2022), a 57.5% decrease in reoperations (from 8.0% to 3.4%, respectively), and an 80% decrease in mortality (from 1.8% to 1.0%, respectively). It is noteworthy that a significant reduction in severe AEs was observed between 2011 and 2022 (56% vs. 15.6%).

Conclusion

A prospective registry of AEs created and maintained by health professionals, along with transparent presentation and discussion of the results, leads to sustained improvement in outcomes in a surgical department of a university hospital.

Keywords:
Adverse effects
Registries
Quality indicators
Quality improvement
Outcome assessment (Health Care)
Resumen
Antecedentes

Se ha debatido mucho sobre las ventajas e inconvenientes del uso de bases administrativas o de registros clínicos en los programas de mejora de la atención médica. El objetivo de este estudio ha sido revisar la implementación y los resultados de una política de evaluación contínua, mediante un registro mantenido por profesionales de un Servicio de Cirugía.

Material y métodos

Se incluyeron, de forma prospectiva, todos los pacientes ingresados en el Servicio entre los años 2003 y 2022. Se anotaron todos los efectos adversos (EAs) acaecidos durante el ingreso, la estancia en centros de convalescencia o en su domicilio durante un período mínimo de 30 días tras el alta.

Resultados

De 60125 registros, en 16802 (27,9%) se registraron 24846 EAs. Hubo un aumento progresivo del número de EAs registrados por ingreso (1,17 en 2003 vs 1,93 in 2022) con una disminución del 26% de los registros con EAs (35,0% en 2003 hasta el 25,8% en 2022), del 57,5% en las reoperaciones (del 8,0 al 3,4%, respectivamente), y del 80% en la mortalidad (del 1,8 al 1,0%, respectivamente). Es de remarcar la reducción significativa de los EAs graves observada entre los años 2011 y el 2022 (56% vs 15,6%).

Conclusión

Un registro propectivo de EAs creado y mantenido por profesionales del servicio, junto con la presentación y discusión abierta y trasparente de los resultados, produce una mejora sostenida de los resultados en un servicio quirúrgico de un hospital universitario.

Palabras clave:
Efectos adversos
Registros clínicos
Indicadores de calidad
Mejoría de la calidad
Valoración de resultados en salud

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