Frequency and content analysis of adverse event reports in surgical centers: a cross-sectional study.

Abstract

Objectives: to identify the frequency of adverse events reported in surgical centers and analyze the content of the reports made.

Methods: a cross-sectional study analyzed reports from January 2019 to March 2023 in eight hospitals, with a sample of 163 reports. The quantitative analysis considered variables such as type and degree of damage, while the qualitative analysis used similarity analysis in Iramuteq.

Results: sixteen never events were identified, including pressure injuries (stages three and four), loss of biopsy material, incorrect surgical procedures, and unintentional retention of a foreign body. The qualitative analysis highlighted terms such as "failures in care", "failure", "surgical procedure", and "pressure injury".

Conclusions: pressure injuries, burns, organ damage, and surgical site infection were the most frequent reports. There is underreporting of adverse events in surgical centers and limitations in the quality of records, including unspecified adverse events and lack of standardization in reporting.