Multicenter evaluation of patient safety incidents in lung surgery: The Epithor Patient Safety Incident study

Objective: To determine the incidence of patient safety incidents (PSIs) occurring during perioperative care for lung surgery and their influence on postoperative outcomes at 90 days.

Methods: A multicenter study was conducted in three French thoracic surgery departments. Consecutive patients older than age 18 years, who had lung surgery (open, video-assisted, or robotic) for benign or malignant diseases were included. PSIs occurring during lung surgery were reported in Epithor, the French national thoracic database. The primary outcome was the incidence of perioperative PSI. Secondary outcomes were the rates of complications, readmission, and mortality at 90 days. All data were prospectively entered in the Epithor database.

Results: From January 1, 2021, to December 31, 2021, 1919 surgical procedures were screened and finally, 953 procedures were included. PSIs were observed in 305 out of 953 procedures (32%) cumulating a total number of 369 PSIs. PSI were related to human factors in 179 lout of 369 (48.5%), organization in 101 out of 369 (27.4%), and technology in 85 out of 369 (23%). PSIs were categorized as near-miss events in 97 (26%), no harm incidents (HI) in 125 (34%), mild HI in 83 (22%), moderate HI in 39 (11%), severe HI in 21 (6%), and mortality in 4 (1%). The relative risk of outcome at 90 days was significantly increased according to PSI severity: no PSI/near-miss versus no-HI/HI: relative risk, 2.02 (95% CI, 1.70-2.40) for complications, 2.51 (95% CI, 1.57-8.30) for readmission, and 3.09 (95% CI, 1.15-8.30) for mortality.

Conclusions: Incidence of PSIs in thoracic surgery may occur in approximately one-third of procedures. Human factors play a crucial role in the occurrence of these PSIs.