A decade-long overview of adverse events in a tertiary surgical service in South Africa

Background. Adverse events are common, and impact patients and healthcare systems negatively. Large international systems investigate adverse events at length, but South African data are lacking. Objectives. To classify all adverse events that have occurred in our department over the last decade. Methods. Ten years of data from a prospectively collated electronic medical record system were analysed for adverse events. All admitted patients were included. Duplicate entries and those that did not describe adverse events were excluded. Results. The study period was from December 2012 to January 2023. There were 52 835 distinct admissions covering 321 385 inpatient days. After categorisation, a total of 14 537 adverse events were captured, giving an adverse event rate of 22%. Adverse events were categorised into four groups. Of the total, 8 027 events were clinical care related, 3 106 were pathology related, 2 662 were system related and 442 miscellaneous. A total of 300 were excluded. Clinical care-related adverse events comprised 57.3% of the total number. Of those, adverse events related to indwelling devices (32.4%), iatrogenic injuries (12.5%) and intravenous therapy administration (12.5%) contributed most. Pathology-related adverse events contributed 21.4% of the total, of which wound sepsis (29.5%), anastomotic leak (15.1%) and nosocomial pneumonia (14.4%) were the most common. There was a general downward trend in reported adverse events from 2016 to 2022. Conclusion. Adverse events are common, and their aetiology is multifactorial. A sustained and multi-faceted approach is needed to address the challenge they pose.