SEARCH · PubMed Health

Results for “Surgical Procedures, Operative”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 307 records · Page 17Linked to original sources

PubMed1984

[In which operations is antibiotic prevention carried out with only a a single dose? Results of a survey among chief physicians in general surgery in German-speaking Switzerland].

We have been asking 108 surgeons in chief of the German speaking part of Switzerland in what operations they are giving an antibiotic prophylaxis. We wanted to know how far the application of the single-dose concept has been entering every day's practice in Switzerland. Its value has been proven in several prospective, randomized, controlled studies. Out of 84 valid questionnaires we could see that single-dose prophylaxis has not yet come into common use, although it is not only more reasonable but also less expensive than a prolonged course. Fortunately, already 90% of the surgeons are giving an antibiotic prophylaxis in colorectal surgery and 53% in biliary tract surgery. A majority of surgeons do not yet provide antibiotic prophylaxis in gastric surgery nor in appendectomies, where the single-dose prophylaxis is effective as well.

Anti-Bacterial Agents↗

PubMed1992

[Cancer of the rectum and sigmoid. Our experience].

The paper reports the Authors' experience during the period 1989-91 and refers to 80 operated cases of rectum-sigma cancer. Given that data reported in the literature affirm that the limit of oncological safety is 1.5-2 centimetres distal from the tumour, and owing to their use of mechanical staplers, the Authors were able to use the preferred anterior section followed by low or very low colo-rectal anastomosis in 96% of cases. Miles' technique for abdomino-perineal amputation was only resorted to in 4% of cases. Tumours parameters, short- and medium-term complications and the results of a short-term follow-up are all discussed. The Authors compare their experience with that of other researchers reported in the literature.

Adult↗

PubMed2007

Six sigma methodology can be used to improve adherence for antibiotic prophylaxis in patients undergoing noncardiac surgery.

BACKGROUND: Six Sigma methodology is a data management process that can be used to achieve a goal of near perfection in process performance. An audit of 615 surgeries over 2 mo revealed only 38% of noncardiac patients admitted on the day of surgery at our institution received perioperative antimicrobial prophylaxis within the target interval of < or =60 min before incision. METHODS: Six Sigma methodology was used to improve our process of timing of antimicrobial prophylaxis administration. A multidisciplinary team was assembled which identified seven process inputs by which patients receive antimicrobial prophylaxis. Interventions for improvement included reinforcement of use of preoperative antibiotic order forms, eliminating administration of antibiotics in the preoperative admission area, and sending appropriate antibiotics and IV tubing with the patient to the operating room. We concurrently developed a control plan to sustain this improvement using a recently deployed electronic anesthesia record keeping system using real-time measurement and reporting capabilities of antimicrobial prophylaxis administration. After defining the new process and undertaking a system-wide educational effort, implementation was begun with data collection and analysis occurring over the next 7 mo. RESULTS: For the 8-mo postintervention interval, there was a significant improvement with 86% of 1716 surgical patients receiving their antibiotic prophylaxis within the specified time frame (P < 0.01). The time interval for antibiotic administration before surgical incision also decreased from a preintervention mean of 88 (CI 56-119 min) to 38 min (CI 25-51 min) (P < 0.01). CONCLUSION: We conclude that Six Sigma methods were used to successfully improve our process for timing of perioperative antibiotic prophylaxis before surgical incision. An electronic anesthesia record keeping system is a useful tool to monitor this process improvement.

Antibiotic Prophylaxis↗

PubMedDate not supplied

The development of paediatric surgery in Papua New Guinea.

Until 1993 complex surgery for children in Papua New Guinea (PNG) was usually conducted by general surgeons, or by overseas paediatric surgeons during ad hoc visits. There had been little coordination of these occasional international visits and no involvement in the surgical teaching program in the University Department of Surgery. Over eight years from July 1993 to July 2000, three Australian surgeons spent 33 weeks teaching paediatric surgery and paediatric urology, using lectures, tutorials and operative demonstration sessions. This paper is a report of the teaching and service provided by one surgeon (PAD) over 27 weeks in PNG and describes the development and training of the surgeon who will be the country's first qualified paediatric surgeon (MM). Other support given has been assistance with the publication of scientific papers, reviews of Masters' theses, the development of a proposal for investigation of the prevalence of renal tract anomalies and the development of protocols for the surgical management of anorectal anomalies and Hirschsprung's disease. In addition to this teaching, 311 children have had surgery during the 11 visits that form the basis of this report. The visits have been supported and funded by AusAID and the Royal Australasian College of Surgeons through the Medical Officer, Nursing and Allied Health Professional (MONAHP) and Pacific Islands Project (PIP) programs. An indication of the impact on the care of children with surgical diseases is evident from the improved skills and the changed referral patterns over the eight years.

Adolescent↗

PubMedDate not supplied

Postoperative host responses in elderly patients after gastrointestinal surgery.

BACKGROUND/AIMS: The age-associated dysregulation of hemodynamic, metabolic and immune responses contributes to the high incidence of complications after major abdominal surgery. METHODOLOGY: Ninety-five patients who underwent gastric resection (n=51) and colorectal resection (n=44) were divided according to age into Groups A (n=45, less than 70 years old), B (n=30, 70-79 years) and C (n=20, over 80 years). Flow cytometric analysis of CD4+ lymphocytes for interferon (IFN)-gamma and interleukin (IL)-4 production determined the Th1/2 balance. Energy expenditure was measured by indirect calorimetry, and hemodynamics were studied using pulse dye densitometry. RESULTS: Surgical procedures, operating time, blood loss and morbidity did not significantly differ among the three groups. The cardiac index (CI) in group A and B increased significantly over preoperative levels until POD 3, but there were no significant perioperative changes in the CI levels of group C. Resting energy expenditure levels changed similarly to those of CI. The postoperative Th1/2 ratio decreased from young to elderly to very elderly patients, although no differences were significant before surgery. The postoperative percentage of CD4+IFN-gamma +T cells (Th1) in group C decreased significantly despite of no significant changes in that of group A and B. In contrast, the ratio of CD4+IL-4+T cells (Th2) in the all groups significantly increased after surgery. CONCLUSIONS: Host responses in elderly patients after major abdominal surgery were more hyperdynamic and hypermetabolic than those of young patients. Postoperative dysregulation of the Th1/2 balance was also associated with aging. However, host responses appear to significantly differ between elderly and very elderly patients.

Aged↗

PubMed1995

Surgery and the release of a neutrophil Fc gamma receptor.

BACKGROUND: The fact that the incidence and mortality from postsurgical sepsis have remained unchanged over the past 15 years raises the possibility that some patients possess an idiosyncratic predisposition to the development of a postoperative sepsis response. Genetic polymorphisms of the neutrophil receptor for immunoglobulin G, CD16, are known, and their inheritance is associated with functional differences in neutrophil phagocytosis. The present studies were designed to provide preliminary data on the effects of surgery on the level of expression of CD16 and its metabolism preparatory to detailed examination of the relationship of these polymorphisms to sepsis responses. PATIENTS AND METHODS: Neutrophil CD16 expression was measured by flow cytometry before and after operation in patients undergoing major resectional surgery of the digestive tract. Assays were performed on whole blood preparations as well as on isolated and activated neutrophil preparations from these patients. RESULTS: Neutrophil CD16 expression was constitutively higher both before and after surgery in patients who developed a postoperative sepsis response than in those who did not. Surgery had no effect on the level of surface neutrophil CD16 expression in either group. Surgery depleted intracellular CD16 stores despite the maintenance of a constant level of CD16 on the neutrophil surface, membrane-bound CD16 being more readily cleaved by physiological neutrophil activators after surgery than before surgery. CONCLUSIONS: The intrinsic level of expression and postsurgical metabolism of neutrophil CD16 may be an important component of the predisposition of some patients to develop infection or sepsis after injury. Further studies of the distribution of CD16 allotypes and neutrophil function among surgical patients are warranted.

Adult↗

PubMed1993

Antimicrobial prophylaxis for surgical wounds. Guidelines for clinical care.

Prophylactic administration of antibiotics can decrease postoperative morbidity, shorten hospitalization, and reduce the overall costs attributable to infections. Principles of prophylaxis include providing effective levels of antibiotics in the decisive interval, and, in most instances, limiting the course to intraoperative coverage only. Use in The National Research Council clean contaminated operations is appropriate and, in many instances, has been proven beneficial. Antibiotic prophylaxis is also indicated for clean operations, such as those involved with insertion of prosthetic devices, that are associated with low infection risk and high morbidity. Extension of antibiotic prophylaxis to other categories of clean wounds should be limited to patients with two or more risk factors established by criteria in the study of the efficacy of nosocomial infection control (SENIC) because the baseline infection rate in these patients is high enough to justify their use. Cefazolin (or cefoxitin when anaerobic coverage is necessary) remains the mainstay of prophylactic therapy. Selection of an alternate agent should be based on specific contraindications, local infection control surveillance data, and the results of clinical trials. Newer criteria for determining the risk of "site infection" (wound and intracavitary) are in evolution and may lead to modification of these recommendations over the next several years.

Anti-Bacterial Agents↗

PubMed1976

The epidemiology of 2056 remote site infections and 1966 surgical wound infections occurring in 1865 patients: a four year study of 40,923 operations at Rush-Presbyterian-St. Luke's Hospital, Chicago.

Over a 4-year period 40,923 operations and 44,716 surgical admissions were monitored for both community and hospital onset infections. One thousand eight hundred sixty-five patients had 1966 surgical wound infections and 2056 remote infections including 1652 hospital onset and 404 community onset infections. One thousand one hudnred forty-four patients with multiple infections averaged 40 days in the hospital contrasted with 24 days for 721 patients with a single wound infection. The total excess cost of hospitalization for these patients was $951,150. A statistically significant reduction occurred for urinary tract infections, lower respiratory infections and clean and contaminated surgical wound infections. It is suggested that these are all inter-related and a significant reduction in surgical wound infections can be achieved through control of infections at remote sites, particularly those associated with medical devices. The coagulase positive staphylococcus is still the most important single bacterial species in the primary etiology of surgical wound infections. When the gastrointestinal tract is entered or "supra" infecting organisms appear, gram negative bacteria and mixed gram negative and gram positive infections are dominant. Reduction in remote site infections occurring in surgical patients is necessary to reduce the incidence of surgical wound infections, suggest preventive and control measures, and document the effectiveness of such measures.

Adolescent↗

PubMed1996

Pathophysiology of infection--a theoretical approach.

The manifestation of postoperative wound infection has a tri-factorial basis: the overall systemic trauma and the additional effects of premorbidity (age, diabetes, etc.), the local host damage resulting from both the accident and surgery, and the bacterial contamination of the wound. The first factor is only moderately open to intervention, however, the amount of local host damage caused during the operation can be influenced directly by the surgeon who must ensure that his operating techniques are non-aggressive and in line with current knowledge. The factor of the intraoperative bacterial inoculum can be modified by attention to hygiene. The latter two factors are in direct relation to the following two hypotheses: Every wound is able to tolerate some local host damage and some bacterial inoculum without manifestation of infection. The bacterial wound flora is the product of the bacterial invasion force and the local wound conditions. The bacterial wound flora and the local condition of the wound are interrelated. If either factor exceeds the tolerable threshold, infection will become manifest, i.e. there will be an uncontrollable proliferation of bacteria. The level of this breaking point may depend upon certain systemic host factors such as age, diabetes, or immunodeficiency. Consequently, the prevention of infection must focus simultaneously on minimizing the local bacterial inoculum and optimizing local wound conditions. Future studies should concentrate on identifying the exact nature of the individual factors promoting infection, their quantification, and their relative importance.

Follow-Up Studies↗

PubMed1978

Influence of the use of a surgical isolator on the rate of infection in the treatment of hydrocephalus.

Two series of patients treated for hydrocephalus (101 original shunt insertions, 81 revisions and 35 reinsertions after infections) have been operated on in the same location, 146 with a surgical isolator (SI), 71 without a SI. Due to temporary poor technical conditions, the use of a SI was decided because, the overall rate of acute postoperative infections had suddenly increased from 9 to 19.7%. Then, although these technical conditions remained unchanged, the use of the SI immediately reduced the overall rate of acute postoperative infections from 19.7 to 7.4%. In original shunt insertions, this rate decreased from 24.9 to 5.8% and in revisions from 10.7 to 5.5%. In reinsertions after infection, it only fell from 27.2 to 16.6%. With the SI, the rate of peroperative contamination is almost nil. If postoperative contaminations due to wound disruption or scalp necrosis, and shunt reinsertions after infection are not taken into account, the rate of acute postoperative infection is 0.8%. The data presented indicate the efficiency of the SI. This results from elimination by the SI of airborne contamination and errors in aseptic technique. These two factors are probably the main sources of infection in shunt insertions for hydrocephalus.

Cerebrospinal Fluid Shunts↗

PubMed1975

The importance of candida as an infectious agent.

During the two and a half year period from January 1971 through Jyly 1973, 23 patients had cultures positive for candida from intra-abdominal isolates. Most of these patients had intestinal or biliary fistulas or abscesses and were seriously ill. Major contributing factors to the development of candidal infections included the extensive use of multiple antibiotics, multiple operations, advanced age, and debility. Thirty additional patients had cultures positive for candida from skin and subcutaneous isolates. Candida appeared to contribute to the poor healing of wounds in some of these patients, particularly those with peripheral vascular ischemic lesions and decubitus ulcers. Antibiotics and concurrent diseases, such as diabetes, cancer, renal failure, and cardiovascular disease, were common factors relating to the development and growth of candida in these patients. There is often considerable difficulty in determing whether or not candida is only a contaminant or is an infectious agent contributing to the illness of the patient. This must be determined in each individual instance. In spite of the fact that candida appeared to be a significant infectious agent in many of these patients, specific antifungal therapy was used sparsely. It is suggested that appropriate antifungal drugs be used in patients with significant disease and that there should be greater awareness of the factors leading to the development of these extremely serious candidal infections.

Adult↗

PubMed2006

A prospective study of outcomes, healthcare resource utilization, and costs associated with postoperative nosocomial infections.

OBJECTIVE: We evaluated 4 important outcomes associated with postoperative nosocomial infection: costs, mortality, excess length of stay, and utilization of healthcare resources. DESIGN: The outcomes for patients who underwent general, cardiothoracic, and neurosurgical operations were recorded during a previous clinical trial. Multivariable analyses including significant covariates were conducted to determine whether nosocomial infection significantly affected the outcomes. SETTING: A large tertiary care medical center and an affiliated Veterans Affairs Medical Center. PATIENTS: A total of 3,864 surgical patients. RESULTS: The overall nosocomial infection rate was 11.3%. Important covariates included age, Karnofsky score, McCabe and Jackson classification of the severity of underlying disease, National Nosocomial Infection Surveillance system risk index, and number of comorbidities. After accounting for covariates, nosocomial infection was associated with increased postoperative length of stay, increased costs, increased hospital readmission rate, and increased use of antimicrobial agents in the outpatient setting. Nosocomial infection was not associated independently with a significantly increased risk of death in this surgical population. CONCLUSION: Postoperative nosocomial infection was associated with increased costs of care and with increased utilization of medical resources. To accurately assess the effects of nosocomial infections, one must take into account important covariates. Surgeons seeking to decrease the cost of care and resource utilization must identify ways to decrease the rate of postoperative nosocomial infection.

Adult↗

PubMed2002

Laparoscopic versus open colorectal surgery: a randomized trial on short-term outcome.

OBJECTIVE: The primary endpoint was to compare the impact of laparoscopic and open colorectal surgery on 30-day postoperative morbidity. Lymphocyte proliferation to mitogens and gut oxygen tension were surrogate endpoints. SUMMARY BACKGROUND DATA: Evidence-based proof of the effect of laparoscopic colorectal surgery on immunometabolic response and clinically relevant outcome variables is scanty. Further randomized trials are desirable before proposing laparoscopy as a superior technique. METHODS: Two hundred sixty-nine patients with colorectal disease were randomly assigned to laparoscopic (n = 136) or open (n = 133) colorectal resection. Four trained members of the surgical staff who were not involved in the study registered postoperative complications. Lymphocyte proliferation to Candida albicans and phytohemagglutinin was evaluated before and 3 and 15 days after surgery. Operative gut oxygen tension was monitored continuously by a polarographic microprobe. RESULTS: In the laparoscopic group the conversion rate was 5.1%. The overall morbidity rate was 20.6% in the laparoscopic group and 38.3% in the open group. Postoperative infections occurred in 15 of the 136 patients in the laparoscopic group and 31 of the 133 patients in the open group. The mean length of hospital stay was 10.4 +/- 2.9 days in the laparoscopic group and 12.5 +/- 4.1 days in the open group. On postoperative day 3, lymphocyte proliferation was impaired in both groups. Fifteen days after surgery, the proliferation index returned to baseline values only in the laparoscopic group. Intraoperative gut oxygen tension was higher in the laparoscopic than in the open group. CONCLUSIONS: Laparoscopic colorectal surgery resulted in a significant reduction of 30-day postoperative morbidity. Lymphocyte proliferation and gut oxygen tension were better preserved in the laparoscopic group than in the open group.

Adenocarcinoma↗

PubMed2000

Modern surgical antibiotic prophylaxis and therapy--less is more.

Recent findings and recommendations on the use of antibiotics in surgery, both prophylactically and as therapy, suggest that adverse events associated with antibiotics remain a major cause of morbidity and mortality. Wound infection rates generally parallel the presence of one or more of three key risk factors; the overall medical condition of the patient, a prolonged operative time, and a contaminated or dirty operative field. The first choice of prophylactic drug should generally be a first- or second-generation cephalosporin, unless the patient is highly allergic to penicillin. Effective prophylaxis can almost always be achieved with a single dose of antibiotic, but the dose must be administered soon before the incision. New guidelines for the prevention of bacterial endocarditis have reduced both the types of cases that require prophylaxis, and the doses of antibiotic necessary to achieve prophylaxis. Some cases that required endocarditis prophylaxis previously no longer require prophylaxis. Rational antibiotic therapy demands rapid diagnosis and treatment. It is also crucial to distinguish among infection, contamination, and inflammation as soon as possible; contamination requires only a single dose of antibiotic, whereas sterile inflammation requires none at all. The choice of antibiotic for postoperative infection, including intra-abdominal infection, should consider the severity of illness and the risk of resistant bacteria. Failure to stratify for risk may prolong treatment unnecessarily, confound the interpretation of future studies, and increase the prevalence of bacterial resistance.

Abdomen↗

PubMed1983

[Sphincter preservation in rectal cancer: possibilities and limits of anterior resection].

The feasibility of sphincter preservation was studied in surgery of tumours in the upper, middle and lower third of the rectum. All patients operated on for rectal cancer between January 1977 and May 1980 were included in the investigation. Preoperative localization of the tumours was performed with the rigid sigmoidoscope. Every patient was scheduled for post-operative follow up. Altogether 211 patients were operated on for rectal cancer. 111 were treated by anterior resection, 90 by abdominoperineal excision, and 10 by other sphincter-saving methods. All of the 59 tumours located in the upper third of the rectum (12 to 16 cm from the anus) were treated by anterior resection. 62 tumours were located in the middle third (8 to 12 cm). In these cases anterior resection was carried out in 60% of the men and in 82% of the women, whereas the other patients underwent abdominoperineal excision. 80 tumours were located in the lower third (4 to 8 cm). Anterior resection was possible in only 4.4% of the men and in 14% of the women. Irrespective of their localization on sigmoidoscopy, 37% of the tumours which were within reach of the finger on rectal palpation could be removed by anterior resection. Local recurrence after anterior resection occurred in 18.3%, the median follow-up time being 50 months. The cumulative probable survival for all stages was more than 5 years for 60% of the patients.

Aged↗

PubMed2003

The use of human fibrin glue in the surgical operations.

Human Fibrin Glue (HFG) is made of two components contained in separate vials: a freeze dried concentrate of clotting proteins, mainly fibrinogen, Factor XIII and fibronectin (the sealant) and freeze dried thrombin (the catalyst). The first component is reconstituted with an aprotinin solution that inhibits tissue fibrinolysis. The second component (thrombin), available in 500 I.U. concentration, is dissolved with calcium chloride. It is so a set of substances involved in the hemostatic process and in the wound healing, conferring to the product the following important properties: hemostatic and sealing action, through the strengthening of the last step of the physiological coagulation; biostimulation, which favors the formation of new tissue matrix. The indications for the use of human fibrin sealant are numerous and present in all the surgical branches. A randomized controlled trial of 50 patients undergoing hernia repair according to Lichtenstein's technique under local anesthesia was performed. Patients had concurrent coagulopathies as a consequence of liver disease or long-term treatment with anticoagulants for ischemic heart disease or cardiac rhythm disturbances. Coagulopathies were defined according to the following criteria: prothrombin time < 10.5 seconds, activated partial thromboplastin time < 21 seconds, and fibrinogen < 230 mg/dL. Patients were randomized in a 1:1 ratio with (group A) or without (control group B) use of human fibrin glue: Postoperative hemorrhagic complications were significantly reduced in group A (4%) compared with group B (24%). This study showed that human fibrin glue is effective in preventing local hemorrhagic complications after inguinal hernia repair in patients with concurrent coagulation disorders.

Cardiac Surgical Procedures↗

PubMed2000

Apoptosis and surgical trauma: dysregulated expression of death and survival factors on peripheral lymphocytes.

BACKGROUND: Surgery and anesthesia cause depression of cell-mediated immunity in the postoperative period, including a reduction in the numbers of circulating lymphocytes. It has been claimed that this immunosuppression is associated with an increased incidence of postoperative infections. HYPOTHESIS: Lymphocytopenia following surgical trauma depends on a dysregulated expression of death/and survival factors associated with apoptosis that, in turn, interferes with the occurrence of postsurgical infections. DESIGN: Fifteen subjects undergoing elective surgery under general anesthesia entered the study. The data of the patients who had infections during the postoperative outcome were compared with the data of those who did not. The data were collected prospectively. MAIN OUTCOME MEASURES: Peripheral blood samples were drawn before the operation, and 24 hours and 96 hours after the operation. Lymphocytes were isolated and examined for quantification and phenotypic analysis of apoptosis using the 7-amino-actinomycin D method, as well as for Fas and Fas ligand, interleukin 1-converting enzyme p20/caspase-1, Bcl-2, and p35 expression. The rate of apoptotic cells was correlated with the incidence of postoperative infections. SETTING: University hospital. RESULTS: Twenty-four hours after surgery, CD4(+) and CD8(+) cells exhibited a significantly higher frequency of apoptosis as well as of Fas and Fas ligand and interleukin 1-converting enzyme p20/caspase-1 expressions than preoperatively. This increase was paralleled by a significant down-regulation of antiapoptotic factors such as Bcl-2. However, the expression of the proapoptotic factor p35 was reduced. In addition, we found a relationship between the rate of the apoptotic CD8(+) subset and the occurrence of infectious complications during the postoperative course. At 96 hours after surgery, the variables studied returned to the baseline levels. CONCLUSIONS: In the early postoperative period, surgical trauma under general anesthesia induces an intracellular perturbation on peripheral lymphocytes, resulting in both up-regulation of death-signaling factors and down-regulation of survival-signaling factors. The increased apoptosis of CD8(+) lymphocytes, but not of CD4(+) cells, seemed to be associated with a greater risk of postsurgical infections.

Analysis of Variance↗

PubMed2002

Complications in surgical patients.

HYPOTHESIS: Complications are common in hospitalized surgical patients. Provider error contributes to a significant proportion of these complications. DESIGN: Surgical patients were concurrently observed for the development of explicit complications. All complications were reviewed by the attending surgeon and other members of the service and evaluated for the severity of sequelae (major or minor) and for whether the complication resulted from medical error (avoidable) or not. SETTING: University teaching hospital with a level I trauma designation. PATIENTS: All inpatients (operative or nonoperative) from 4 different surgical services: general surgery, combined general surgery and trauma, vascular surgery, and cardiothoracic surgery. MAIN OUTCOME MEASURES: Total complication rate (number of complications divided by the number of patients) and the number of patients with complications. Complications were separated into those with major or minor sequelae and the proportion of each type that were due to medical error (avoidable). Rates of complications in a recent Institute of Medicine report were used as a criterion standard. RESULTS: The data for the respective groups (general surgery, vascular surgery, combined general surgery and trauma, and cardiothoracic surgery) are as follows. The number of patients was 1363, 978, 914, and 1403; number of complications, 413, 409, 295, and 378; total complication rate, 30.3%, 42.4%, 32.3%, and 26.9%; minor complication rate, 13.3%, 19.9%, 13.5%, and 13.0% (percentage of minor complications that were avoidable, 37.4%, 59.0%, 51.2%, and 49.5%); major complication rate, 16.2%, 21.1%, 18.1%, and 12.9% (percentage of major complications that were avoidable, 53.4%, 60.7%, 38.8%, and 38.7%); and mortality rate, 1.83%, 3.33%, 2.28%, and 3.34% (percentage of mortality that was avoidable, 28.0%, 44.1%, 19.0%, and 25.0%). CONCLUSIONS: Despite mortality rates that compare favorably with national benchmarks, a prospective examination of surgical patients reveals complication rates that are 2 to 4 times higher than those identified in an Institute of Medicine report. Almost half of these adverse events were judged contemporaneously by peers to be due to provider error (avoidable). Errors in care contributed to 38 (30%) of 128 deaths. Recognition that provider error contributes significantly to adverse events presents significant opportunities for improving patient outcomes.

Cardiac Surgical Procedures↗