title: Incidence of adverse events related to health care in Spain: results of the Spanish National Study of Adverse Events.
abstract: OBJECTIVE
  To determine the incidence and incidence density of adverse events (AEs) in Spanish hospitals (including the pre-hospitalisation period).
  
  
  METHODS
  Retrospective cohort study.
  
  
  RESULTS
  The incidence of patients with AEs relating directly to hospital care was 8.4% (95% CI 7.7% to 9.1%) and rose 9.3% (95% CI 8.6% to 10.1%), including those from the pre-hospitalisation period. The incidence density was 1.2 AEs per 100 patient-days (95% CI 1.1 to 1.3). The incidence of moderate and serious AEs was 5.6 AEs per 1000 patient-days (95% CI 4.9% to 6.3%). In 66.3% of AEs, additional procedures were required and in 69.9% additional treatments were required. In total 42.8% of AEs were considered as avoidable. Of the subjects with some intrinsic risk factors, 13.2% developed AEs compared with 5.2% of the subjects who had no risk factors (p<0.001), and 9.5% of the subjects who had some extrinsic risk factors developed AEs compared with 3.4% of the subjects who had not (p<0.001). Patients older than 65 years of age showed a higher frequency of AEs than those under this age (12.4% vs 5.4%, p<0.001, RR 2.5). The most frequent AEs were those associated with medication (37.4%), hospital infections of any type (25.3%) and those relating to technical problems during a procedure (25.0%). A total of 31.4% of the AEs involved an increase in the length of stay. The AEs associated with medical assistance caused 6.1 additional hospital stays by patient.
  
  
  CONCLUSIONS
  The incidence of patients with AE related to medical assistance in Spanish hospitals was relevant and similar to those found in the studies from Canada and New Zealand that had been conducted with comparable methodology. Patient vulnerability has been identified therein as playing a major role in generating healthcare-related AEs. These and other recent results indicate the need for AEs to be considered a public health priority in Europe.
authors.affiliation: Department of Preventive Medicine, Teaching Hospital of Sant Joan d'Alacant, Spain. aranaz_jes@gva.es
authors.forename: J M
authors.initials: JM
authors.lastname: Aranaz-Andrés
authors.forename: C
authors.initials: C
authors.lastname: Aibar-Remón
authors.forename: J
authors.initials: J
authors.lastname: Vitaller-Murillo
authors.forename: P
authors.initials: P
authors.lastname: Ruiz-López
authors.forename: R
authors.initials: R
authors.lastname: Limón-Ramírez
authors.forename: E
authors.initials: E
authors.lastname: Terol-García
mesh_terms: D000367:Age Factors; D000368:Aged; D015331:Cohort Studies; D003695:Delivery of Health Care / Q000706:statistics & numerical data*; D006276:Health Facility Size; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007049:Iatrogenic Disease / Q000453:epidemiology*; D015994:Incidence; D007902:Length of Stay; D008485:Medical Audit; D019300:Medical Errors / Q000706:statistics & numerical data*; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology