Incidencia y evitabilidad de acontecimientos adversos en hospitales: un estudio retrospectivo

Lima Júnior, Antônio José de; Zanetti, Ariane Cristina Barboza; Dias, Bruna Moreno; Bernardes, Andrea; Gastaldi, Francielly Marques; Gabriel, Carmen Silvia

Antônio José de Lima Júnior

conception or design of the study/research

analysis and/or interpretation of data

final review with critical and intellectual participation in the manuscript

Universidade de São Paulo. Ribeirão Preto, São Paulo, Brazil

https://orcid.org/0000-0003-2459-9719

Ariane Cristina Barboza Zanetti

analysis and/or interpretation of data

final review with critical and intellectual participation in the manuscript

Universidade de São Paulo. Ribeirão Preto, São Paulo, Brazil

https://orcid.org/0000-0002-4458-3274

Bruna Moreno Dias

final review with critical and intellectual participation in the manuscript

Universidade de São Paulo. Ribeirão Preto, São Paulo, Brazil

https://orcid.org/0000-0002-7346-4848

Andrea Bernardes

final review with critical and intellectual participation in the manuscript

Universidade de São Paulo. Ribeirão Preto, São Paulo, Brazil

https://orcid.org/0000-0002-9861-2050

Francielly Marques Gastaldi

analysis and/or interpretation of data

final review with critical and intellectual participation in the manuscript

Hospital de clínicas de Uberlândia. Uberlândia, Minas Gerais, Brazil

https://orcid.org/0000-0002-5307-4156

Carmen Silvia Gabriel Corresponding author: Carmen Silvia Gabriel, E-mail: cgabriel@eerp.usp.br

conception or design of the study/research

final review with critical and intellectual participation in the manuscript

Universidade de São Paulo. Ribeirão Preto, São Paulo, Brazil

https://orcid.org/0000-0003-2666-2849

Corresponding author: Carmen Silvia Gabriel, E-mail: cgabriel@eerp.usp.br

EDITOR IN CHIEF: Dulce Barbosa

ASSOCIATE EDITOR: Jules Teixeira

SCREENING CRITERIA
1. Prior hospitalization in the past 12 months in patients younger than 65, or prior hospitalization in the past 6 months in patients 65 and older.
2. Antineoplastic treatment in the 6 months prior to hospitalization.
3. Trauma, accident, or fall during hospitalization.
4. Unwanted medication effect.
5. Fever above 38.3º C on the day before scheduled discharge.
6. Transfer from a general inpatient unit to an intensive or semi-intensive care unit.
7. Transfer to another acute care hospital.
8. Second surgical intervention during this hospitalization.
9. After performing an invasive procedure, an injury has occurred to an organ or system that will require clinical or surgical treatment.
10. Neurological change missing on admission but present during the study period.
11. AMI (acute myocardial infarction), stroke, or PTE (pulmonary thromboembolism) during or after an invasive procedure.
12. Cardiac arrest or low APGAR score
13. Injury or complication related to abortion, amniocentesis, labor, or prepartum.
14. Death
15. Unplanned open surgical intervention or admission for intervention, whether laparoscopic or open, after a scheduled outpatient intervention.
16. Some injury or complication related to an outpatient surgery or invasive procedure that resulted in hospitalization or evaluation in the emergency department.
17. Any type of infection associated with care.
18. Documentation or correspondence in the medical record (including a property claim) regarding the care that could suggest litigation.
19. Any other unwanted occurrence not mentioned above.

Variables	Adverse event				Total (n=80)		p value
	Present (n=58)		Absent (n=22)		Total (n=80)
	n	%	n	%	n	%
Gender							0.897^* * Pearson's chi-square test;
Male	37	63.8	13	59.1	50	62.5
Female	21	36.2	9	40.9	30	37.5
Age group (years)							1.000^* * Pearson's chi-square test;
<60	31	53.4	12	54.5	43	53.8
≥60	27	46.6	10	45.5	37	46.2
Education							0.781^ Fisher's exact test.
Incomplete elementary school	6	10.3	0	0.0	6	7.5
Complete elementary school	23	39.7	4	18.2	27	33.7
Complete High School	3	5.2	0	0.0	3	3.8
Incomplete high school	1	1.7	0	0.0	1	1.2
Complete higher education	3	5.2	0	0.0	3	3.8
None	10	17.2	0	0.0	10	12.5
No information	12	20.7	18	81.8	30	37.5
Race							0.448^ Fisher's exact test.
White	23	39.7	10	45.5	33	41.2
Black	4	6.9	3	13.6	7	8.8
Brown (Pardo)	31	53.4	9	40.9	40	50.0
Comorbidity							1.000^ Fisher's exact test.
Absent	8	13.8	3	13.6	11	13.8
Present	50	86.2	19	86.4	69	86.2
CID-10 Chapters							0.015^ Fisher's exact test.
I	12	20.7	0	0.0	12	15.0
II	3	5.2	4	18.2	7	8.8
VI	1	1.7	1	4.5	2	2.6
IX	11	19.0	0	0.0	11	13.7
X	3	5.2	2	9.1	5	6.2
XI	5	8.6	3	13.6	8	10.0
XII	1	1.7	0	0.0	1	1.2
XIII	0	0.0	1	4.5	1	1.2
XIV	5	8.6	3	13.6	8	10.0
XVIII	1	1.7	1	4.5	2	2.6
XIX	15	25.9	7	31.9	22	27.5
XXI	1	1.7	0	0.0	1	1.2
Intrinsic risk factors							0.541^ Fisher's exact test.
Absente	12	20.7	3	13.6	15	18.7
Present	46	79.3	19	86.4	65	81.3
Extrinsic risk factors							-
Absente	0	0.0	0	0.0	0	0.0
Present	58	100	22	100	80	100
Prognosis of the disease motivating hospitalization:
Full recovery to baseline health							0.033^ Fisher's exact test.
No	35	60.3	19	86.4	54	67.5
Yes	23	39.7	3	13.6	26	32.5
Recovery with residual disability							0.772^ Fisher's exact test.
No	15	25.9	5	22.7	20	25.0
Yes	43	74.1	17	77.3	60	75.0
Terminal illness							0.283^* * Pearson's chi-square test;
No	52	89.7	17	77.3	69	86.3
Yes	6	10.3	5	22.7	11	13.7
Hospitalization type							0.033^* * Pearson's chi-square test;
Urgency	49	84.5	13	59.1	62	77.5
Elective	9	15.5	9	40.9	18	22.5
Hospital exit type							0.889^ Fisher's exact test.
Discharge	41	70.7	15	68.2	55	68.7
Death ≤24h	2	3.4	0	0.0	2	2.5
Death >24h	15	25.9	7	31.8	23	28.8
Hospitalization time (days)							0.615^ Fisher's exact test.
<3	11	19.0	2	9.1	13	16.3
3 to 10	15	25.9	6	27.3	21	26.2
>10	32	55.1	14	63.6	46	57.5
Hospitalization sector							0.038^ Fisher's exact test.
Clinical	10	17.2	4	18.2	14	17.5
Surgical	27	46.6	16	72.7	43	53.8
Intensive Care	21	36.2	2	9.1	23	28.7

Variables	Adverse event Severity						Total		p value
	Mild		Moderate		Severe		Total
	n	%	n	%	N	%	N	%
AE Classification									0,545^ Fisher's exact test.
Related to general care	5	33.3	5	33.3	5	33.3	15	100
Related to medication	0	0.0	4	66.7	2	33.3	6	100
Related to hospital infection	7	14.6	25	52.1	16	33.3	48	100
Related to the procedure	2	8.0	14	56.0	9	36.0	25	100
Related to diagnosis	0	0.0	1	25.0	3	75.0	4	100
Others	0	0.0	3	75.0	1	25.0	4	100
Avoidability of AE									1.000^ Fisher's exact test.
Not avoidable	0	0.0	1	100	0	0.0	1	100
Avoidable	14	13.9	51	50.5	36	35.6	101	100
Comorbidity									0.105^ Fisher's exact test.
Absent	3	37.5	2	25.0	3	37.5	8	100
Present	11	11.8	49	52.7	33	35.5	93	100
Hospitalization sector									0.079^ Fisher's exact test.
Clinical	3	12.5	15	62.5	6	25.0	24	100
Surgical	8	22.2	12	33.3	16	44.5	36	100
Intensive/Semi-intensive Care	3	7.2	25	59.5	14	33.3	42	100
Prognosis of the disease motivating the hospitalization:
Full recovery to baseline health									0.000^ Fisher's exact test.
No	3	4.2	38	53.5	30	42.3	71	100
Yes	11	35.5	14	45.2	6	19.3	31	100
Recovery with residual disability									0.341^* * Pearson's chi-square test;
No	7	12.1	27	46.5	24	41.4	58	100
Yes	7	15.9	25	56.8	12	27.3	44	100
Terminal illness									0.595^ Fisher's exact test.
No	12	13.5	47	52.8	30	33.7	89	100
Yes	2	15.4	5	38.5	6	46.1	13	100

Variables	Adverse event		Crude OR (95% CI)	Crude p value	Adjusted OR (95% CI)	Adjusted p value
Variables	Present n (%)	Absent n (%)	Crude OR (95% CI)	Crude p value	Adjusted OR (95% CI)	Adjusted p value
Hospital
A	23 (39.7)	18 (81.8)	Ref	Ref	Ref	Ref
B	35 (60.3)	4 (18.2)	6.85 (2.05.22.83)	0.002	6.8 (1.97.23.55)	0.002
Gender
Male	37 (63.8)	13 (59.1)	Ref	Ref	-	-
Female	21 (36.2)	9 (40.9)	0.82 (0.3.2.24)	0.698	-	-
Age group (years)
<60	31 (53.4)	12 (54.5)	Ref	Ref	-	-
≥60	27 (46.6)	10 (45.5)	1.05 (0.39.2.8)	0.930	-	-
Education					-	-
Elementary school complete or incomplete	29 (50.0)	4 (18.2)	0 (0.Inf)	0.995	-	-
High school complete or incomplete or higher education	7 (12.1)	0 (0.0)	Ref	Ref	-	-
None	10 (17.2)	0 (0.0)	1 (0.Inf)	1.000	-	-
No information	12 (20.7)	18 (81.8)	0 (0.Inf)	0.994	-	-
Comorbidity
Absent	8 (13.8)	3 (13.6)	Ref	Ref	-	-
Present	50 (86.2)	19 (86.4)	0.99 (0.24.4.12)	0.985	-	-
ICD-10 Chapters
I	12 (20.7)	0 (0.0)	115648793.27 (0.Inf)	0.992	-	-
IX. X. XI. XIV	24 (41.4)	8 (36.3)	1.91 (0.53.6.84)	0.321	-	-
XIX	15 (25.9)	7 (31.9)	4.5 (1.20.31)	0.050	-	-
II. VI. XII. XIII. XVIII. XXI	7 (12.0)	7 (31.8)	Ref	Ref	-	-
Hospitalization type
Urgency	49 (84.5)	13 (59.1)	3.77 (1.24.11.41)	0.019	3.73 (1.1.12.61)	0.034
Elective	9 (15.5)	9 (40.9)	Ref	Ref	Ref	Ref
Hospitalization sector
Clinical	10 (17.2)	4 (18.2)	Ref	Ref	-	-
Surgical	27 (46.6)	16 (72.7)	0.67 (0.18.2.51)	0.558	-	-
Intensive/Semi-intensive Care	21 (36.2)	2 (9.1)	4.2 (0.66.26.9)	0.130	-	-

[1] Corresponding author: Carmen Silvia Gabriel, E-mail: cgabriel@eerp.usp.br

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Incidencia y evitabilidad de acontecimientos adversos en hospitales: un estudio retrospectivo

RESUMEN

Objetivos:

Métodos:

Resultados:

Conclusiones: