title: Risk of Intraoperative Injury of Nearby Structures: National Trend, Distribution, and Burden.
abstract: BACKGROUND
  Accidental injury of a nearby structure during surgical operations carries a risk of serious morbidity and mortality. Furthermore, it represents a medico-legal liability. We aimed to examine the national distribution, cost, and trend of accidental intraoperative injuries.
  
  
  METHODS
  We performed a cross-sectional study using the Nationwide Inpatient Sample database. The study population consisted of patients who encountered intraoperative injuries between 2003 and 2010. Controls were randomly selected from patients who underwent similar procedures during the same period. Cost was adjusted for inflation rate to reflect 2015 dollar values.
  
  
  RESULTS
  A total of 61,667 cases with intraoperative injuries and 430,424 controls were included. Intraoperative injuries were most common in procedures that involved the digestive system (38.0%), female reproductive organs (21.4%), and musculoskeletal system (12.2%). There was a significant increase in those injuries from 161.3 cases/100,000 procedures in 2003 to 254.9 cases/100,000 procedures in 2010 (p < 0.001). Female sex, pediatric and older populations, overweight, trauma and teaching hospital were all independent risk factors of injuries in the multivariate model (p < 0.05 for all). Intraoperative injuries were associated with a higher risk of concomitant complications (odds ratio [OR] 2.44, 95% CI 2.36, 2.54, p < 0.001) and hospital mortality risk (OR 2.33, 95% CI [2.15, 2.51], p < 0.001). Nationally, it is estimated that injuries of nearby structures resulted in an annual average of 84,708.7 days of excess hospital admission days and $426.33 million excess cost.
  
  
  CONCLUSIONS
  Certain demographic and clinical factors influence the risk of intraoperative injury of nearby structures. The prevalence of intraoperative injuries is increasing at the national level, and these injuries are associated with increased mortality and pose substantial clinical and financial burdens.
authors.affiliation: Department of Surgery, Tulane University School of Medicine, New Orleans, LA.
authors.forename: Zaid
authors.initials: Z
authors.lastname: Al-Qurayshi
authors.affiliation: Department of Biostatistics and Bioinformatics, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA.
authors.forename: Sudesh
authors.initials: S
authors.lastname: Srivastav
authors.affiliation: Department of Surgery, Tulane University School of Medicine, New Orleans, LA.
authors.forename: Douglas P
authors.initials: DP
authors.lastname: Slakey
authors.affiliation: Department of Surgery, Tulane University School of Medicine, New Orleans, LA. Electronic address: ekandil@tulane.edu.
authors.forename: Emad
authors.initials: E
authors.lastname: Kandil
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D007431:Intraoperative Complications; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012189:Retrospective Studies; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D055815:Young Adult