My 80-year-old neighbor recently reported that she’d undergone what’s called a cardiac ablation to remedy her troubling irregular heartbeat. She isn’t one to delve into the grisly details, but the procedure, I learned later, involves guiding a catheter through a vein leading to the heart where it creates small scars in the heart tissue — a procedure that tends to block the irregular rhythms.
She said the whole thing took about an hour or so. No problem.
We’ve become so accustomed to these sorts of minor medical miracles that we routinely expect that we’ll return from any trip to the operating room completely cured of whatever ailed us — or at least return no worse off than when we arrived there. That’s why it’s so difficult to digest cases like that of a septuagenarian cousin of mine, whose recent gall bladder surgery went sideways for reasons only the surgeon can probably explain.
She developed pneumonia after the surgery and her kidneys began to malfunction. A few days later, her fever spiked dangerously, and a CT scan detected some intestinal leakage, sending her back under the knife. Eight hours later, she emerged intubated and strapped to a colostomy bag. It was, according to one of her siblings, looking pretty grim. A death watch seemed imminent.
Thankfully, she has rallied in recent days, overcoming a spate of infections with the help of a few courses of antibiotics, but her doctors say she will be in the hospital for several more weeks before she’s completely recovered. It’s an ordeal nobody could’ve predicted, but recent research suggests that our generally sanguine expectations of modern surgical magic may be misplaced. Such postoperative crises are much more common than you might imagine.
Harvard University researchers, reviewing the health records of 1,009 patients admitted to 11 Massachusetts hospitals for surgery in 2018, found that more than a third suffered “adverse events” as a result of a surgical procedure — “with nearly half constituting major events resulting in serious or life-threatening harm to patients, or death.”
Researchers estimated that the postoperative problems encountered by about one in four patients were potentially preventable; about one in 10 patients experienced issues that were clearly preventable. Most problematic were procedures involving the heart and lungs, followed by gut and digestive system surgery.
The study, published earlier this month in The BMJ, was designed to determine whether surgical outcomes had improved in the years since the Harvard Medical Practice Study first raised alarms about patient safety in 1991. The results, according to lead study author David Bates, MD, suggest that not much has changed. “It’s clear that the problem has not gone away,” he tells CNN. “If anything, it’s even bigger than it was.”
The seminal Harvard study sparked a 1999 report from the National Academy of Sciences, which amplified the issues and led to some improvements in our healthcare system, including electronic recordkeeping to alert physicians to potential medication interactions, presurgery checklists, and increased monitoring of postsurgery sepsis and other dangerous conditions.
But patients tend to be older and sicker now than they were a generation ago, and surgical procedures tend to involve more risk. And that suggests we’re fortunate that the frequency of postoperative crises isn’t any higher than it is, argues Kedar Mate, MD, a patient-safety advocate who heads the Institute for Healthcare Improvement. “The fact that our overall adverse event rate is about the same as it was 20 years ago is in some ways an accomplishment, even though the rate of harm is still far too high and far too great,” he says.
That’s small consolation to Helen Haskell, whose teenage son died 25 years ago as a result of a postsurgery medication that caused internal bleeding and septic shock. In a BMJ editorial accompanying Bate’s study, Haskell, who founded Mothers Against Medical Error, cites various reasons for the lack of progress, including inadequate nurse staffing, an inability to implement proven strategies and available technology, and a culture that disrespects the patient. “All undoubtedly have played a part,” she writes. “The major omission in patient safety, however, is the patient.”
While patient engagement has improved in some areas of the healthcare system, Haskell argues that it’s badly lagging in areas where patients and their families could most contribute: reviewing and correcting errors in their electronic medical records. “When an adverse event occurs, patients and families are seldom interviewed, much less consulted, even if they are the sole witnesses,” she notes. “Confidential analyses of root causes and ‘disclosures’ with confidentiality clauses may do more to hide problems about patient safety than to address them.”
Liability concerns on the part of hospitals and their practitioners will likely continue to obstruct the sort of transparency and collaboration Haskell believes is needed to improve patient safety in the years ahead. But patients and their loved ones are not entirely blameless, she argues. “These are longstanding issues that are not really being properly addressed, because I think they’re not as high in the consciousness of either patients or healthcare providers as they should be.”
I have a feeling my cousin would agree.
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