title: Opening Pandora's box: understanding the nature, patterns, and 30-day outcomes of intraoperative adverse events.
abstract: BACKGROUND
  Little evidence exists regarding the characteristics of intraoperative adverse events (iAEs).
  
  
  METHODS
  Administrative data, the American College of Surgeons - National Surgical Quality Improvement Project, and systematic review of operative reports were used to confirm iAEs in abdominal surgery patients. Standard American College of Surgeons - National Surgical Quality Improvement Project data were supplemented with variables including injury type/organ, phase of operation, adhesions, repair type, and intraoperative consultations.
  
  
  RESULTS
  Two hundred twenty-seven iAEs (187 patients) were confirmed in 9,292 patients. Most common injuries were enterotomies during intestinal surgery (68%) and vessel injuries during hepatopancreaticobiliary surgery (61%); 108 iAEs (48%) specifically occurred during adhesiolysis. A third of the iAEs required organ/tissue resection or complex reconstruction. Because of iAEs, 20 intraoperative consults (11%) were requested and 9 of the 66 (16%) laparoscopic cases were converted to open. Thirty-day mortality and morbidity were 6% and 58%, respectively. The complications included perioperative transfusions (36%), surgical site infection (19%), systemic sepsis (13%), and failure to wean off the ventilator (12%).
  
  
  CONCLUSIONS
  iAEs commonly occur in reoperative cases requiring lysis of adhesions and possibly lead to increased patient morbidity. Understanding iAEs is essential to prevent their occurrence and mitigate their adverse effects.
authors: Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital & Harvard Medical School, Boston, MA 02114, USA; Department of Surgery, MedStar Washington Hospital Center, Washington, DC 20010, USA.
authors: Michael N
authors: MN
authors: Mavros
authors: Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital & Harvard Medical School, Boston, MA 02114, USA.
authors: George C
authors: GC
authors: Velmahos
authors: Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital & Harvard Medical School, Boston, MA 02114, USA.
authors: Andreas
authors: A
authors: Larentzakis
authors: Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital & Harvard Medical School, Boston, MA 02114, USA.
authors: Daniel Dante
authors: DD
authors: Yeh
authors: Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital & Harvard Medical School, Boston, MA 02114, USA.
authors: Peter
authors: P
authors: Fagenholz
authors: Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital & Harvard Medical School, Boston, MA 02114, USA.
authors: Marc
authors: M
authors: de Moya
authors: Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital & Harvard Medical School, Boston, MA 02114, USA.
authors: David R
authors: DR
authors: King
authors: Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital & Harvard Medical School, Boston, MA 02114, USA.
authors: Jarone
authors: J
authors: Lee
authors: Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital & Harvard Medical School, Boston, MA 02114, USA. Electronic address: hkaafarani@mgh.harvard.edu.
authors: Haytham M A
authors: HM
authors: Kaafarani
mesh_terms: D000368:Aged; D013505:Digestive System Surgical Procedures / Q000592:standards*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007049:Iatrogenic Disease / Q000453:epidemiology*; D007431:Intraoperative Complications / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology; D058996:Quality Improvement; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D014481:United States / Q000453:epidemiology
keywords: Accidental puncture or laceration; Intraoperative adverse event; Outcomes