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Despite decades of calls for more attention to patient safety in hospitals, people undergoing surgery still have high rates of complications and medical errors, a new study shows.

More than a third of patients admitted to the hospital for surgery have adverse events related to their care, and at least 1 in 5 of these complications are the result of medical errors, researchers found.

Studies looking at adverse events and medical errors in the hospital setting are few and far between, and each has slightly different methods, so their results are not always an apples-to-apples comparison. But the one the last studywhich was published Thursday in the BMJ, fits into a pattern of evidence going back several decades suggesting that hospitals have not made much progress in patient safety.

“It’s pretty disturbing,” said Helen Haskell, an expert who became a reluctant advocate for patient safety after her son, Lewis Blackman, died at age 15 of complications from surgery. to correct a condition called pectus excavatum or sunken chest. She wrote an editorial which was published along with the new study.

A drug given to her son to control pain caused a hole in his digestive tract called a perforated ulcer, which led to internal bleeding, an infection and septic shock. Haskell says she watched her previously healthy and athletic son deteriorate before her eyes.

“I couldn’t get anyone’s attention and he just died. He was in agony for 30 hours and then he died,” she said.

If she had survived, she said, it would have been almost 40 years ago, which is hard to think about.

After his death, Haskell founded the group Mothers Against Medical Error, which promotes patient safety in hospitals.

Haskell says it’s frustrating to see patients continue to be affected by the care they receive in hospitals.

“These are longstanding issues that really aren’t being addressed properly because I think they’re not as high in the consciousness of patients or healthcare providers as they should be,” she said.

For the new study, a team of researchers based at Harvard University set out to copy the careful methods of the Harvard Medical Practice Study, a study conducted in the 1980s, which was one of the first to detail patient injury rates in healthcare. His conclusions became the basis for a 1999 report from the National Academies of Sciences called “To Err is Human,” which raised the alarm about patient safety issues in health care settings.

“We’re trying to figure out, have things changed? Are they better?” said dr. David Bates, professor of health policy and management at Harvards TH Chan School of Public Health, who led the new research.

Since the original study, there have been important changes in hospitals that are designed to make surgery safer. Electronic medical records can send alerts, for example, if someone is prescribed two drugs that could interact dangerously. Surgeons also routinely use checklists before surgery, something that wasn’t always done four decades ago. There have also been campaigns to make doctors and patients aware of hidden conditions such as sepsis, which can quickly turn into death.

However, the new study found that safety issues persist.

“It is clear that the problem has not gone away. If anything, it’s even bigger than it was,” Bates said.

Bates says it’s hard to directly compare the findings of the older Harvard study with the newer one because so much about healthcare delivery itself has changed over the past 40 years. For the older study, for example, researchers looked at paper charts. This time, they used electronic medical records.

Patients are also different. In many cases, people in hospitals are sicker than before, and procedures have become riskier and more complex, said Dr. Kedar Mate, president and CEO of the nonprofit Institute for Healthcare Improvement, an organization that advocates for patient safety.

Given this greater degree of difficulty, “the fact that our overall rate of adverse events is about the same as it was 20 years ago is in some ways an achievement, even if the rate of harm is still far too high and far too high .” said Mate, who was not involved in the new study.

Akin Demehin, senior director of quality and patient safety at the American Hospital Association, said hospitals and health systems are continually working to promote patient safety and quality. Demehin pointed towards recent data from the US Centers for Disease Control and Prevention, which showed a decrease in healthcare-associated infections.

The research looked at the outcomes of more than 1,009 people admitted to 11 Massachusetts hospitals in 2018 for surgery.

The researchers say this was the most recent data they could look at, given how long it took for all hospitals to agree to participate (1 1/2 years) to collect all the records they needed. (2 years), require nurses to review records and identify potential adverse events (1 year). Doctors then spent another four months checking the events and deciding whether these problems appeared to be preventable, according to study researcher Dr. Antoine Duclos, who directs the Healthcare Performance Research Laboratory at Claude Bernard University in Lyon, France.

Of the 1,009 patients operated on, 383 (38%) experienced at least one adverse event. About half of those events — 160 — were considered serious or life-threatening, the study said.

More than 250 surgery patients, or about 1 in 4, had at least one adverse effect, even one that was considered to be potentially preventable, while 103, or about 10%, had events that were considered to be certainly preventable or the result of medical errors. By the proportion of patients who had adverse events, approximately 60% were determined to be potentially preventable and approximately 20% were considered to be definitely preventable.

The most common types of complications were related to the surgery itself, followed by medication errors and healthcare-associated infections.

The study found that the risk of a complication increased with the age of the patient and the type of procedure they had. Operations involving the heart and lungs had the highest complication rates, followed by operations on the bowel and digestive system, and procedures involving bones and joints.

These incidents most commonly occurred outside the operating room, usually once the patient returned to the hospital room. These include things like falls and pressure ulcers, Bates said.

Most hospitals have a policy of regularly reviewing cases where patients have been injured with their doctors, but they do so for a small fraction of the total, Bates added.

Bates said standard approaches to finding adverse events identify only about 5 percent of cases.

“It’s a much bigger problem than most hospitals recognize,” he said.

Matt agrees. “It’s high and awful, and it should be alarming to everyone in the industry and it’s paying attention.”

The study has several important limitations. All of the hospitals that participated were in Massachusetts, and although the researchers tried to include hospitals of different sizes in different parts of the state, it’s unclear whether these results would be the same in other states or regions of the US.

The study authors also limited their focus to patients admitted to the hospital for surgery. It may not apply to other settings, such as ambulatory surgery centers, which tend to handle less complex procedures.

The study also relied on electronic medical records, which are prone to errors, the researchers noted.

Still, advocates say the study should put a renewed focus on patient safety.

Bates says reducing surgical complications is a task for hospitals and doctors, but there are things patients can do to reduce their risk of complications.

“It’s useful, for example, to know what medications you’re taking and keep track of what the doses are,” he said.

It’s also a good idea to bring someone with you to the hospital if you’re having surgery.

“Often people who are in the hospital are not that mentally alert,” Bates said, “They’re not their usual selves or they’re not in pain. So if you have someone else, whether it’s a friend or a loved one, it can be very helpful.”