• Michael N Mavros, George C Velmahos, Andreas Larentzakis, Daniel Dante Yeh, Peter Fagenholz, Marc de Moya, David R King, Jarone Lee, and Haytham M A Kaafarani.
• Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital & Harvard Medical School, Boston, MA 02114, USA; Department of Surgery, MedStar Washington Hospital Center, Washington, DC 20010, USA.
• Am. J. Surg. 2014 Oct 1;208(4):626-31.

BackgroundLittle evidence exists regarding the characteristics of intraoperative adverse events (iAEs).MethodsAdministrative data, the American College of Surgeons - National Surgical Quality Improvement Project, and systematic review of operative reports were used to confirm iAEs in abdominal surgery patients. Standard American College of Surgeons - National Surgical Quality Improvement Project data were supplemented with variables including injury type/organ, phase of operation, adhesions, repair type, and intraoperative consultations.ResultsTwo hundred twenty-seven iAEs (187 patients) were confirmed in 9,292 patients. Most common injuries were enterotomies during intestinal surgery (68%) and vessel injuries during hepatopancreaticobiliary surgery (61%); 108 iAEs (48%) specifically occurred during adhesiolysis. A third of the iAEs required organ/tissue resection or complex reconstruction. Because of iAEs, 20 intraoperative consults (11%) were requested and 9 of the 66 (16%) laparoscopic cases were converted to open. Thirty-day mortality and morbidity were 6% and 58%, respectively. The complications included perioperative transfusions (36%), surgical site infection (19%), systemic sepsis (13%), and failure to wean off the ventilator (12%).ConclusionsiAEs commonly occur in reoperative cases requiring lysis of adhesions and possibly lead to increased patient morbidity. Understanding iAEs is essential to prevent their occurrence and mitigate their adverse effects.Copyright © 2014 Elsevier Inc. All rights reserved.

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