Adverse Events due to Surgical Procedures Among Pediatric Inpatients: The Japan Adverse Event Study

Objectives: Adverse events (AEs) and medical errors (MEs) related to surgery in pediatric inpatients are critical concerns. However, comprehensive epidemiological data across pediatric surgeries remain limited. We aimed to examine the detailed epidemiology of AEs and MEs related to surgery. Methods: We analyzed data from the Japan Adverse Events Study, a retrospective cohort study conducted at 2 tertiary care teaching hospitals in Japan. We included patients who underwent surgery, classified as major or minor. Major surgeries involved access to major body cavities or deep structures with anatomic modification, whereas minor surgeries involved only superficial approaches. Results: Of 328 surgical patients [4261 patient-days], 87 had major and 241 had minor surgeries. The median age was 1 year (interquartile range: 0-8) in the major surgery group and 4 years (interquartile range: 1-7) in the minor surgery group ( P = 0.03). A total of 292 AEs were identified: 156 in the major and 136 in the minor surgery group (83 versus 57 per 1000 patient-days, P = 0.001). Life-threatening AEs occurred numerically more frequently in the major surgery group (5% versus 2%, P = 0.53). The incidence of MEs was similar (33 versus 37 per 1000 patient-days), but MEs were more likely to result in AEs in the major surgery group [22/61 (36%) versus 14/88 (16%), P = 0.005]. Conclusions: AEs occurred more frequently, and MEs were more likely to result in AEs in the major than in the minor surgery group. These findings suggest that perioperative patient safety strategies should be tailored according to surgical invasiveness.