IT HAPPENS EVERYWHERE-SURGICAL "NEVER EVENTS" IN USA 

More than 4000 surgical "never events" occurred each year between 1990 and 2010 in the United States, according to the findings of a retrospective study of national malpractice data. Winta T. Mehtsun, MD, MPH, from the Johns Hopkins University School of Medicine in Baltimore, Maryland, and colleagues estimate that such errors cost the healthcare system millions of dollars each year in malpractice payments alone.

The investigators published their findings online December 18 in Surgery.

The authors note that some steps have already been implemented to reduce the incidence of surgical never events. "In an effort to incentivize patient safety in surgery, payers are increasingly focusing on these events that should never take place (surgical never events) as metrics of quality care," the authors write. "Medicare and several states have already announced that hospitals will be penalized for such events in pay-for-performance programs."

To estimate the frequency of these events, the authors reviewed data in the National Practitioner Data Bank (NPDB) to identify malpractice settlements and judgments related to surgical never events occurring between September 1, 1990, and September 30, 2010. The authors found that a total of $1.3 billion was paid in 9744 malpractice settlements and judgments related to surgical never events during the study period.

The authors excluded payments to dentists, pharmacists, social workers, and nurses.

Using NPDB data and literature claim estimates, the authors estimated that surgical never-event claims occur at a rate of 4082 per year. Of the physicians involved, 62% (5903/9562) were named in multiple malpractice reports and 12.4% (1199/9562) were named in multiple surgical never-event malpractice reports.

In multivariate analysis, physicians subjected to clinical privilege or state licensure disciplinary actions were more likely to be named in multiple surgical never-event claims (adjusted odds ratio [aOR], 1.73; 95% confidence interval [CI], 1.47 - 2.03; P < .001) and physicians with multiple malpractice claims were more likely to have a payout above the mean (aOR, 1.19; 95% CI, 1.08 - 1.32; P < .001). In addition, physicians aged 50 to 59 years were more likely to have multiple surgical never-event claims than those younger than 40 years (aOR, 1.47; 95% CI, 1.13 - 1.93; P = .01). Physicians in other age groups (40-49 years, 60 years or older) were not significantly more or less likely to be involved in a malpractice claim than those younger than 40 years.

The authors adjusted multivariate analyses for physician years in practice, practitioner age, and presence or absence of multiple malpractice reports.

Limitations of the study include the potential underreporting of surgical never events because the NPDB records only paid claims on behalf of physicians, but not unpaid claims or claims paid on behalf of corporate entities. Additionally, the investigators note that a lack of hospital-level data, a lack of data on physician specialties, and a lack of data on types of surgeries and payments are also limitations.

Because of these limitations, the researchers say their estimates of frequency and costs of never events are likely to be underestimates compared with the actual figures.

The authors conclude that despite the work of multiple organizations, more effort is needed to reduce the incidence of surgical never events. "For a fraction of the costs associated with surgical never events, we can monitor patterns of these errors better and ultimately discover effective approaches to eliminating them," the authors write. "Investment is needed to create more robust, mandatory data collection systems concerning surgical never events, including subsequent thorough investigations by surgical health service researchers."

The authors have disclosed no relevant financial relationships.

Surgery. Published online December 18, 2012. Abstract