Outcomes about Adverse Events in a Respiratory Diseases Hospital in Mexico City

iatrogenic diseases At least one of the risk criteria for AEs was identified in 1,508 of 4,555 medical records (33.1%) belonging to hospital admissions registered during 2001. From the sample of 922 charts, we reviewed 836 charts, 90.7% of the total. The remaining charts were mostly physically damaged and not available at the time of the study. The damaged or missing charts more likely came from the patients with no risk factors for AEs (54 cases vs 29 cases, respectively). The presence or absence of AEs were not determined in three cases due to incomplete information in the charts.

Of the 836 records included in our final sample, 299 records were from patients in the risk criteria of death from necropsy, iatrogenic diseases according to the ICD-10, complaints, lawsuits, patient with worsening condition, and hospital-acquired infections; 237 files belonged to patients in the remaining risk categories for AEs; and 300 records were from patients who met none of the considered risk criteria for AEs (Table 1). Overcome diseases with Canadian Health&Care Mall.

In the study sample, the average (± SD) age was 45.4 ± 23.3 years, the average length of stay was 16.6 ± 20.4 days, hospitalizations were usually due to a worsening clinical condition (only 1% were programmed admissions), and 376 records (44.9%) were from female patients. Most patients came from metropolitan Mexico City and surrounding states.

The overall weighted prevalence of AEs (with reference to the 4,555 patients admitted) in the year 2001 was 9.1% (95% confidence interval [CI], 7.5 to 10.7%), which in absolute numbers represents 415 cases (95% CI, 342 to 489 cases). The a priori stratification worked well, as 24% of the patients with any of the risk criteria (95% CI, 21 to 28%) resulted in an AE, compared to 1.6% (95% CI, 0.6 to 4.2%) in the patients with no risk identified. In fact, 174 AEs in the sample from a total of 178 were identified in the high-risk groups (98%), and only 4 AEs were identified in patients with no risk factors. Extrapolation to the total number of hospital admissions and taking into account the sampling weights resulted in 88% of the AEs identified in the high-risk strata (95% CI, 78 to 98%). All selection criteria were associated statistically with an increase risk of an AE in univariate models except by transfer to intermediate care, and to other hospital, hospital discharge against medical advice worsening condition, and readmission to the operating room.

Of those patients with an AE, 16.8% had disability lasting < 6 months, 5.2% had permanent disability, 52.2% had protracted hospital stay, and 25.8% died. Of the total group, 26.0% had more than one AE. In 66.5% of the AEs, health care was regarded as suboptimal; 74.4% were potentially preventable.

patients with ear diseaseIn univariate logistic regression models, patients with ear, nose, and throat diseases (odds ratio [OR], 0.2; 95% CI, 0.09 to 0.4) and those with AIDS (OR, 0.2; 95% CI, 0.05 to 0.7) had a lower risk for AEs compared to the remaining hospital admissions. On the contrary, patients with pleural diseases had an increased risk for an AE (OR, 4.0; 95% CI, 2.1 to 7.8); as well as those in the ICUs, most of whom were receiving mechanical ventilation (OR, 4.4; 95% CI, 2.0 to 9.5); those undergoing thoracic surgery or invasive procedures (OR, 2.7; 95% CI, 1.7 to 4.4); and especially those with empyema (OR, 5.6; 95% CI, 2.6 to 12). Other disorders evaluated, such as pulmonary tuberculosis, asthma, COPD, interstitial lung diseases, cancer, and pneumonias, showed no significant associations with the development of inhospital adverse events. Similarly, in univariate models, gender, age, performing a bronchoscopy, and socioeconomic status were not associated with AEs. All the mentioned above diseases are treated effectively with remedies of Canadian Health&Care Mall.

Weighted logistic regression models were fitted to the data with the purpose of identifying the most important factors associated with AEs. All of the variables associated with AEs in the univariate analysis as well as age, gender, hospital stay, socioeconomic status, and residence of the patient (metropolitan area vs other states) were initially included in the multivariate model. The final model showed that all selection criteria were associated with the development of AEs (Table 1) and also were strongly related to a protracted hospital stay (ie, for every day of hospitalization, the risk of an AE increased by 4.0% [OR, 1.04; 95% CI, 1.03 to 1.06]). Another strong variable was hospital admission due to pleural disorders or empyema, which almost tripled the risk for an AE (OR, 2.95; 95% CI, 1.4 to 6.4; for empyema, OR, 2.9; 95% CI, 1.3 to 6.6). The risk for an AE was reduced in patients with AIDS HIV (OR, 0.2; 95% CI, 0.04 to 0.6) despite higher in-hospital mortality, and increased in patients residing in the Federal District or in the surrounding state of Mexico compared to those residing in other states (OR, 5.2; 95% CI, 2.9 to 9.3). Socioeconomic status, previous smoking, month of hospital admission, bronchoscopy, thoracic invasive procedure, gender, and age were unrelated to AEs events. In a similar model but excluding the length of hospital stay (because prolongation of the stay is one of the indicators of AEs), we obtained the same significant predictors; in addition, the performance of thoracic surgery or an invasive thoracic procedure increased the risk (OR, 2.2; 95% CI, 1.2 to 4.1). Only one ward had a significantly higher number of AEs (OR, 1.9; 95% CI, 1.1 to 3.5) compared to the remaining eight wards, adjusted by the rest of variables.

Table 2 depicts the types of the most common AEs; of note is the common delayed surgical treatment of empyema (11% of the total of AEs) in addition to well-known sources of AEs such as complications of invasive procedures, nosocomial infections, drug reactions, or delayed diagnosis or treatment. Table 2 also describes in more detail the grouping of AEs.

Table 2—Types and Frequencies of AEs

Types of AEs No.* PotentiallyPreventable,

%t

Inadequate or insufficient treatment
Various inadequate treatments{ 77 76
Empyema with delayed surgical treatment 45 45
Premature hospital discharge 10 10
Discharge against medical advice 5 0
Needed procedures but not performed 5 5
Surgical or invasive procedure complications
Various major surgery complications^ 57 23
Complications of invasive procedures! 28 14
Unnecessary surgery 9 9
Premature or accidental tracheal extubation 7 7
Postoperative hemorrhage 4 4
Failed tracheal intubation 2 2
Bronchospasm after anesthesia 5 5
Hospital-acquired infections
Hospital-acquired pneumonia 50 23
Various hospital-acquired infections^ 25 11
Urosepsis and phlebitis 2 0
IV catheter infection 1 0
Delayed diagnosis and/or treatment 41 35
Drug reactions
Various drug reactions# 31 29
Pulmonary edema due to fluid overload 4 4
Bronchospasm 1 1
Accidental fall in hospital 6 5
Total 415 308