Misadventures to patients during surgical and medical care in England and Wales: an analysis of deaths and hospital episodes.

Objectives To estimate incidence of injury to patients attributed to misadventures during surgical and medical care by age group and to examine recent trends. Design Analysis of routine morbidity and mortality data categorized by the 9th and 10th revisions of the International Classification of Diseases. Participants Children 0-14 years and adults ≥15 years. Setting England and Wales during 1999 to 2008 (hospital episodes) and 1979 to 2009 (deaths). Main outcome measures We calculated deaths per million person-years and per 1000 hospital episodes; hospital episodes per 100,000 person-years and per 100,000 procedures performed. Results The rate of death attributed to misadventures during surgical and medical care in patients aged 75 years and older was over 50 times (rate ratio 57.2; 95% confidence interval 38.3-85.3) higher than in children aged 1-14 years. Estimated hospital episode rates were 20 times (RR 20.0; 18.9-21.2) higher in patients aged 75 years and older. Mortality attributed to misadventures declined from 1.1 (0.9-1.4) deaths per million person-years in 1979 to 0.4 (0.2-0.6) in 2009. Hospital episodes of misadventures decreased between 1999 and 2008 from 30.8 (29.9-31.8) episodes per 100,000 procedures to 23.25 (22.5-24.1), but increased from 7.8 (7.6-8.1) per 100,000 person-years to 9.8 (9.5-10.1). Conclusions Misadventures during surgical and medical care are an important cause of avoidable injury. Older patients appear to be at higher risk of experiencing and dying from misadventure. Interpretation of recent trends is limited by uncertainties regarding the consistency and coverage of coding.