Impact of Adverse Healthcare Events on Patients After Gastrointestinal Surgery

This article discusses the impact of adverse healthcare events on patients who have undergone gastrointestinal surgery. It covers common adverse events, such as surgical errors and wound infections, and explores the causes and prevention strategies for these events. The article also addresses the effects of these events on patients' health and provides recommendations for post-surgery care.

What is the impact of adverse healthcare
events on patients who have undergone
gastrointestinal surgery?

Contents
INTRODUCTION.............................................................................3
Aim and Objectives........................................................................9
Research question........................................................................10
REFERENCES................................................................................11

INTRODUCTION
Adverse events are broadly defined as all those incidents and injuries that are caused to
individuals who are seeking medical and healthcare in healthcare settings (Pearse and et.al,
2014). There are various types of adverse events that can be caused at the time of surgical
interventions and other procedures. Some of these adverse events can be prevented by
implementing effective strategies and plans. Although there are many surgical pre-operative and
post-operative adverse events that takes place in gastrointestinal surgery but these are some of
the common adverse events that generally takes place in healthcare settings (Collaborative,
2014). Adverse events are selected on the basis of frequency with which they occur and the
evidence which is required to measure and monitor them accurately. Common adverse healthcare
events in gastrointestinal surgery are surgical wound, infection, anastomotic leak, deep vein
thrombosis and surgical mortality. There are many types of adverse events that can take place in
gastrointestinal surgery. Events such as surgical errors, diagnosis errors, medication errors and
wrong site and patient surgical errors (Basch and et.al, 2014). Surgical errors can be defined as
those mistakes in surgery that can be prevented to maximum extent if proper medical practices
are adopted by all the physicians and surgeons. In almost all the surgeries there is certain risk
involved which depends on the type of surgical intervention a person is going through. This is
the reason it is very difficult for all the relatives and partners to sign the consent form before the
surgery of the patient. The form which is signed by relatives and family members is known as
consent form and it includes that surgical errors are unexpected and are preventable up to a
certain extent. In case of gastrointestinal surgery there can be many adverse events related to
surgery which should be taken care of (Pucher, Aggarwal and Darzi, 2014). One of the most
common surgical error that can take place in gastrointestinal surgery is injury to the specific
nerve during the injury. In many cases it is noticed that due to incompetence surgeon fails to
perform the surgery in correct manner. In cases of failure of surgical procedure it is possible that
the surgeon has not performed the surgery many times and was not aware of procedures to be
implemented while performing gastrointestinal surgery. Other reason for increased number of
surgical errors in surgery is insufficient pre-operative planning by physicians and other surgeons.
It is expected that surgeons prepared themselves prior to surgery so that chances of
complications are not increased during the procedure (Sjöström and et.al, 2012). If surgeons are
not prepared for the surgery then chances of complications increases to maximum. Nurses and
other individuals who will be assisting in surgical procedure should also keep all the equipments

ready so that it is available when surgeons need it at the time of surgery. Improper work process
can also be one of the surgical errors that can be seen in surgery. In majority of the cases it is
noticed that in order to complete the surgery in short span of time many surgeons take shortcuts
which proves to be costly to the patient as well as the physicians.
There are many types of surgical wound infections that can be caused to patient who has
undergone gastrointestinal surgery. Wound infection can be defined as the secretion of pus or
serous fluid which contains large amount of pathogens and bacteria surrounded to them. The
infections are also associated with immunodeficiency (Mavros and et.al, 2014). There are many
factors which influences the cause of infection prior and after the surgery. If the wounds or the
incision part after the surgery is not sealed or stitched properly then there are chances that pus
will discharge leading to contamination of the wound to a higher extent. Chances of wounds
increases more in individuals who are above the age of 70 years. In case of gastrointestinal
surgery there are increased chances of occurrence of urinary tract infection in both males and
females (Vester-Andersen and et.al, 2014). There are ways through which these infections can be
prevented before and after gastrointestinal surgery. It is very necessary for all the surgeons to use
aseptic methods and avoid the use of antibiotics so that surgical site infection is reduced to
maximum. Other surgical errors can be caused due to poor communication, fatigue and influence
of drugs and alcohol. Miscommunication or poor communication can also cause different errors
in gastrointestinal surgery (Valero III, and et.al, 2015). For example a surgeon may detect a
wrong site of surgery or may fail to ensure that all the surgical equipments are available in the
surgical room prior to surgery. There can be medication error or a doctor on duty may prescribe
wrong dosage to the patient which may lead to fatal effects on his/her health. Fatigue is one of
the most common issue which is faced by surgeons who are working under long shift and are not
able to get rest due to their schedule. As compared to well rested surgeons, practitioners or
surgeons who do not take rest are likely to make more mistakes during any type of surgery.
Although surgeons and other physicians do not consume alcohol when they are on medical duty
but it is surprising to see that many surgeons are under the influence of drugs and alcohol to cope
with underlying stress (Sjöström and et.al, 2012). The influence of different substance and
alcohol can lead to major surgical errors during gastrointestinal surgery. Other surgical errors can
be neglecting different aspects which are very necessary to be considered when performing a
major organ surgery on patients. Due to irresponsible behaviour or negligence, surgeons may
forge to ensure that all the surgical instruments are working in proper conditions prior to surgery.
Sometimes, due to negligence surgeons may use defective surgical instruments which can cause

surgical site infection to the patient who is undergoing gastrointestinal surgery (Collaborative,
2014).
Injury to nerve is one of the most common error which is cause by surgeons when they
are performing any type of surgery. Injury to nerve can be the result of use of infected or
defective surgical instruments which have rust coating on it (Underwood and et.al, 2014) .
Although surgeons and other physicians take care of such accidents but due to negligence this
error is likely to happen. Apart from negligence there can be medication errors which are very
common in gastrointestinal surgeries. According to research it was reported that 7.2 % of overall
death after the surgeries is caused due to the administration of wrong dose of different
medications or anaesthesia to the patient. In most of the cases the dose of anaesthesia can not be
reverted back which cause death of the patient after sometime (Angiolillo and et.al, 2012).
Making an incision on wrong location is also one of the most adverse events that can be
experienced by patients who are undergoing various types of surgeries. For example if a tumour
clot is detected on left side of the GI tract there can be accidents when surgeons may make an
incision on the opposite part of the infected side. This can lead to severe complications such as
coma or death of the patient. While performing major surgeries it is very necessary to ensure that
no surgical instrument, sponge, piece of cotton or cloth is left in the patient body (Pearse and
et.al, 2014). If any equipment, or other material is left in patients body then it proved to be fatal
because depending upon material it can lead to injuries and complications in the body which can
prove to be fatal. Before taking the sutures in the cut skin it is very necessary to ensure that no
part of surgical instrument, sponge or cotton is left in the skin. Operating on wrong body part is
also one of the most common adverse healthcare events that is generally experienced by patients
who are undergoing gastrointestinal surgery. For example a person has been diagnosed a defect
in digestive system and has been operated for cardiovascular disease is a kind of surgical error
which is very common when many patients have been diagmosed with the same problem (Shaw
and et.al, 2013).
Another adverse effect which is very common in gastrointestinal surgery is anastomotic
leak. It is generally noticed in oesophageal and cardiac surgeries (Pucher, Aggarwal and Darzi,
2014). The anastomotic leak occurs due to anastomosis. One of the main reason for anastomosis
is the aggregate edge on suture ligation is either too loose or too tight. Anastomotic is likely to
occur when the stomach which has been operated has free anastomotic tension or consistent
margins that can narrow the passage of stomach easily. Oesophagus is considered to be
segmental blood supply of the body. In gastrointestinal surgery either it is too long or it is too
short which hinders the oesophagus to circulate blood throughout the body (Sjöström and et.al,

2012). This causes ischemic injury to gut lining and stomach walls which affects normal healing
of the wound by anastomotic leak.
Indigestion commonly also known as dyspepsia is defined as difficulty in digesting food. The
incomplete or improper digestion of food is generally characterized by increased burning
sensation in the stomach which is followed by discomfort and pain in upper part of the abdomen.
Best remedy for treating the issue of indigestion is by changing the lifestyle pattern and dietary
habits which can enhance digestion in a person who has undergone gastrointestinal surgery
(Underwood and et.al, 2014). The condition deteriorates if a person is on alcohol and aspirin
intake. If change in lifestyle does not prove to be beneficial then a person can be prescribed of
various types of antacids and H2 blockers which can increase considerable amount of digestion.
Alcoholism and gastrointestinal surgery has a bidirectional link because there are increased
chances of consumption of alcohol in patients who have undergone surgical intervention
(Angiolillo and et.al, 2012). When a person is operated of intestinal surgery the stomach size of
is change and doctor advised to avoid many food items, beverages and drugs so that stomach is
able to regain its normal function and structure after the surgery. It is very important to consult
the doctors or respective gastro-entronology surgeons so that they can give better suggestions
about what things should avoided after surgery (Shaw and et.al, 2013). If a person do not avoid
restricted food, beverages and drugs then the chances of damage to the pouch automatically
increases which further leads to peptic and gastric ulcers. Drugs such as Motrin, Aleve, aspirin
and Advil should be avoided because increased intake of pain relievers in gastrointestinal
surgery enhances the chances of ulcers (Pearse and et.al, 2014). According to research it is stated
that alcohol in low amount is acceptable after the surgery but it also produces various types of
effects on body which can be fatal. Firstly, all the beverages contains large amount of calories
which gets deposited in the liver and adipose tissue.
Secondly the chances of becoming intoxicated after surgery are very common. Hence,
doctors’ advice that alcohol intake after gastrointestinal surgery is likely to produce more side-
effects as compared to consumption before surgery (Collaborative, 2014). Person who has the
habit o smoking tobacco should quit the habit of smoking after being treated with surgical
intervention of gastrointestinal surgery because an individual who smokes is at a greater risk of
developing ulcers and cancer in his/her pouch due to inflammation and burning of tissues. Apart
from these side-effects and there are many other adversities that are produced in individuals who
have undergone gastrointestinal surgery at early or later stages of life. Common side-effects are
nausea, vomiting, change in bowel habits, dehydration, diarrhoea, loss motions and renal calculi.

Although all these adverse reaction and events can be controlled by different ways but it is very
necessary to prevent the symptoms so that chances of other complications are reduced
(Birkmeyer and et.al, 2013). One of the most potential side-effect of gastrointestinal surgery that
has been noticed in individuals is nausea and vomiting. More than 70% of the people who have
undergone gastric bypass suffer from the problem of nausea and vomiting. On an average it is
reported that a person who has been treated of various digestive issues feels nauseous 6 times a
week and report the occurrence of vomiting 2 times a day (Baron, Kamath and McBane, 2013).
For preventing nausea and vomiting doctors generally recommend the patient to be on is IV
fluids so that the intake of water is increased and there are less chances of a person suffering
from nausea and vomiting. Change in bowel habits is also one of the common side-effects that
are caused mostly in patients with gastrointestinal surgery. Sometimes it may lead to diarrhoea
and loose stools whereas very often it is characterized by constipation (Basch and et.al, 2014). A
person who has been operated with gastrointestinal bypass is advised to remove dairy and milk
products from the diet because it leads to lactose intolerance. The problem of lactose intolerance
is not caused by gastrointestinal surgery but due to this the patient become more susceptible to
side-effects that are produced due to surgery.
Deep vein thrombosis is also one of the most common adverse event that takes place in
gastrointestinal surgery after the procedure is completed (Shaw and et.al, 2013). It can be defined
as formation of blood clot generally known as thrombus in the deep vein of the body. Signs
which are not specific can be intense pain, swelling, redness of skin, warming of skin and
formation of superficial veins. Pulmonary embolism is also one of the adverse effects that is
cause postoperatively in patients who have undergone gastrointestinal surgery. In surgeries such
as total hip replacement, gastrointestinal surgery, bypass surgery and hip fracture operation there
are increased chances of venous thrombosis. If procedure is prophylaxis is not used there are
more than 5% chances that deep vein thrombosis and pulmonary embolism will be caused in less
than 35 days (Collaborative, 2014).
Once a person has undergone gastrointestinal surgery it is very important to provide
correct nutritional balance to him/her so that they recover at a faster rate (Underwood and et.al,
2014). It has been noticed that after postoperative procedure the metabolic rate is likely to be
increased by 10%. Due to the increased rate of metabolism the body needs adequate amount of
nutrition so that it is able to balance the diet on regular basis. If proper nutrition and diet is not
provided to the individual then it may lead to skeletal proteolysis. This has a negative impact on
the mental and physical health of a person and may lead to depression in metabolic rate
(Angiolillo and et.al, 2012). When a person is operated there are chances of changes produced at

hormonal levels. Increase in energy expenditure also leads to change in hormonal levels which
can be characterized by increased level of catecholamine. Apart from metabolic changes
produced in surgical patients there are physiological changes that are produced in the body.
Based on various studies and researches it has been clinically proved that there are many types of
physiological changes that are produced in the body after a person has underwent gastrointestinal
surgery (Shaw and et.al, 2013). Intestinal permeability in a normal person without a surgery is
two to four folds less. But a person who has undergone surgery tends to increase the intestinal
permeability by two to four folds. In addition to increase in intestinal permeability the depletion
at nutritional value is also likely to take place due to decrease in height of villous (Pearse and
et.al, 2014). Studies have aimed at investigating ways which can be helpful in treating
postoperative symptoms associated with gastrointestinal surgery in all the patients. There are
many other side effects which are produced due to increased permeability of intestine. Bacteria
and toxins which are of endogenous nature should be excluded from intestine during the normal
process. But due to the enlargement of stomach and increased permeability of intestine those
bacteria and toxins are not able to be excluded from the body (Collaborative, 2014). This is also
the result of failure of gut that indicates the non-removal of endogenous bacteria and toxins.
According to studies it has been stated that these types of bacteria and toxins which are present
in intestine are likely to cause systematic inflammation syndrome, sepsis and multi-organ failure
in most of the cases.
Rate of surgical mortality in case of gastrointestinal surgery has been increased from
25.7% to 30.8% in recent years. The outcomes stated after the surgery are very poor and to
mitigate the adverse healthcare events after the surgery it is very necessary to adopt various
strategies and frameworks which can reduce the surgical mortality in surgical patients (Mavros
and et.al, 2014). Operative factors, condition of the patient abnormal vital signs loss of blood in
surgery are all the factors which have increased the mortality. Based on the studies it has been
stated that if surgical outcomes of gastrointestinal surgery is not improved then this percentage is
likely to rise up to 35.1% in the upcoming years.
Although there are many adverse health outcomes which are produced in patients who
have undergone gastrointestinal surgery, but, there are clinical benefits as well which helps a
person to improve their mental and physical health (Birkmeyer and et.al, 2013). Studies
associated with gastrointestinal surgery reveals that postoperative nutritional support provided to
the entire patient significantly decreased the morbidity rate and length of hospital stay. It has also
been noticed that good nutritional support provided to all the malnourished individuals are likely
to improve the physical health of patient. Pulmonary embolism is a type of adverse event that is

characterized by sudden obstruction in blood vessel that is produced due to bubble or circulation
of blood in the blood vessels (Baron, Kamath and McBane, 2013). Blood clot is originated in the
vein, leg or pelvis part which leads to laboured breathing angina pectoris, faintness and heart
palpitations. Leaks are also one of the most common side effects that are produced in
gastrointestinal surgery. Leaks happen when staple lines that are connected to the surgical
connections of the gastrointestinal tract leads to leakage of all the food and fluid particles from
digestive contents into abdomen. The main symptoms of leaks are fever, pain in chest and
increased rate of heart beats in a person (Basch and et.al, 2014). In order to prevent leaks during
the surgery it is very necessary for surgeons to ensure that all the surgical connections are made
correctly. If leaks are not discovered in correct manner then it can be solved by resting the
stomach which is fed with intravenous fluids. If the severe conditions are not resolved with the
help of IV fluids, surgery is needed to solve the leakage issues in individuals who have
undergone gastrointestinal surgery (Vester-Andersen and et.al, 2014). Last but not the least is
small bowel obstruction which is also known as internal hernia. Many patients are likely to suffer
from this problem anytime from 1 to 7 years after the surgical intervention. This occurs when
intestine is not able to digest food and fluids and it prevents the flow due to intestine twisting.
Many patients who suffer from small bowel obstruction or internal hernia are likely to suffer
from abdominal pain, swelling, inflammation and vomiting. CAT scan helps in diagnosing
internal hernia issues after surgery (Pucher, Aggarwal and Darzi, 2014).
What?
The overall dissertation report will be based on the impact of adverse healthcare events on
patients who have undergone gastrointestinal surgery (Sjöström and et.al, 2012). There are
different types of metabolic and physiological changes that occur in a body of an individual who
has undergone gastrointestinal surgery. Metabolic changes can be characterized by increase rate
of catecholamine hormonal rates which leads to fluctuations in negative nitrogen balance in the
body. There are many other symptoms such as nausea, vomiting, hair loss, change in bowel
habits and kidney stones (Mavros and et.al, 2014). According to research it has been stated that
more than 70% of people who have been operated suffers from nausea and vomiting. Hair loss is
also one of the common symptoms that are noticed in most cases. It is mostly produced in
females who have undergone surgical interventions. In many cases hair growth is regained in 3-6
months of the surgery but change in healthy diet habits can also lead to increased hair growth in
surgical patients. Physiological changes such as increase in intestine permeability are one of the
common reasons which are also responsible for multiple organ failure and other inflammatory

infections (Valero III, and et.al, 2015). Other changes and symptoms also include pulmonary
embolism, leaks and bowel obstruction which can further lead to constipation and diarrhoea.
Why?
This is one of the major issues because of change in lifestyle and dietary habits in individual’s
life. Change in lifestyle can be one of the main reasons which can lead to different types of
disruptions in the body (Underwood and et.al, 2014). The causes of gastrointestinal problems
such as constipation, loose motions, vomiting, feeling of nausea and hair loss depends widely on
different reasons. Mal-absorption disorder can be one of the reasons which can cause
gastrointestinal problems to a greater extent. Inflammation in large and small intestine triggers
the increase of gastrointestinal issues due to various foods and beverages. Crohn’s disease is
types of digestive disorder that can be characterized by inflammatory bowel diseases due to
change in bowel habits (Angiolillo and et.al, 2012). Constipation, diarrhoea and loose motions
are the most common causes of Crohn’s disease. Diarrhoea can be interchangeably used with
dehydration which leads to expulsion of large volume of water and fluid from body. This leads to
weight loss and weakness in a person who has undergone gastrointestinal surgery. This issue can
be solved with the help of incorporating fluid intake and fibre supplements in the diet.
Gastrointestinal problems increase if a person is suffering from ulcers in small intestine (Shaw
and et.al, 2013).
How?
The overall dissertation will be completed by systematically reviewing all the research articles
and research papers which are relevant to studies (Birkmeyer and et.al, 2013). Generally there
are two types of researches that can be used to complete the research in proper manner. In this
current dissertation, secondary research will be used which is characterized by reviewing all the
past studies systematically. All the articles which are based on the adverse impacts of
gastrointestinal surgery will be selected. The articles and research papers selected for the
completion of this dissertation and research which will be based on inclusion and exclusion
criteria (Baron, Kamath and McBane, 2013). Inclusion and exclusion criteria are generally
designed to select all the articles which are relevant to the ongoing studies. Inclusion criteria
defines that all the articles which are related to gastrointestinal surgery will be selected. If
articles are not published in English language it will not be selected in the studies and it will be
excluded from the dissertation part. Also those articles will not be included in the dissertation
that has been printed before 2007 (Basch and et.al, 2014). Different articles include various

studies such as Meta analysis, cohort studies, randomised control trials and qualitative studies
which can help in completing of studies in effective manner.
Aim and Objectives
Aim
“To systematically review the impact of adverse healthcare events on patients who have
undergone gastrointestinal surgery”
Objectives
The objectives of the research are as follows:
 To identify different reasons which leads to gastrointestinal
problem in individuals?
 To understand the importance of gastrointestinal surgery in
GI tract problems.
 To understand the impact of adverse health events on
patients who have undergone gastrointestinal surgery.
 To recommend suitable suggestions to mitigate the
adversities that is produced in gastrointestinal surgery.
Research question
PEO is a type of framework that is used for qualitative study. Population of different age and
gender are selected so that the study can help in completing the study successfully. In this
dissertation PEO framework has been used.
 P: Gastrointestinal patients
 E: Adverse events/ Medical errors
 O: Impact/ Experience
1. How are gastrointestinal surgical patients affected by adverse healthcare events
after the surgical intervention?

REFERENCES
Books and Journals
Angiolillo, D.J. and et.al., 2012. Bridging antiplatelet therapy with cangrelor in patients
undergoing cardiac surgery: a randomized controlled trial. Jama, 307(3), pp.265-274.
Barker, L.A. and et.al., 2013. Preoperative immunonutrition and its effect on postoperative
outcomes in well-nourished and malnourished gastrointestinal surgery patients: a
randomised controlled trial. European journal of clinical nutrition,67(8), pp.802-807.
Baron, T.H., Kamath, P.S. and McBane, R.D., 2013. Management of antithrombotic therapy in
patients undergoing invasive procedures. New England Journal of Medicine, 368(22),
pp.2113-2124.
Basch, E. and et.al., 2014. Development of the National Cancer Institute’s patient-reported
outcomes version of the common terminology criteria for adverse events (PRO-
CTCAE). Journal of the National Cancer Institute, 106(9), p.dju244.
Birkmeyer, J.D. and et.al.,2013. Surgical skill and complication rates after bariatric surgery. New
England Journal of Medicine,369(15), pp.1434-1442.
Collaborative, S., 2014. Impact of postoperative non-steroidal anti-inflammatory drugs on
adverse events after gastrointestinal surgery. Br J Surg, 101(11), pp.1413-1423.
Mavros, M.N. and et.al., 2014. Opening Pandora's box: understanding the nature, patterns, and
30-day outcomes of intraoperative adverse events. The American Journal of
Surgery, 208(4), pp.626-631.
Pearse, R.M. and et.al., 2014. Effect of a perioperative, cardiac output–guided hemodynamic
therapy algorithm on outcomes following major gastrointestinal surgery: A randomized
clinical trial and systematic review. Jama, 311(21), pp.2181-2190.
Pucher, P.H., Aggarwal, R. and Darzi, A., 2014. Surgical ward round quality and impact on
variable patient outcomes. Annals of surgery, 259(2), pp.222-226.
Shaw, M. and et.al., 2013. Safety and efficacy of ulimorelin administered postoperatively to
accelerate recovery of gastrointestinal motility following partial bowel resection: results
of two randomized, placebo-controlled phase 3 trials. Diseases of the Colon &
Rectum, 56(7), pp.888-897.
Sjöström, L. and et.al., 2012. Bariatric surgery and long-term cardiovascular
events.Jama, 307(1), pp.56-65.
Underwood, P. and et.al., 2014. Preoperative A1C and clinical outcomes in patients with
diabetes undergoing major noncardiac surgical procedures. Diabetes Care, 37(3), pp.611-
616.

Valero III, V. and et.al., 2015. Sarcopenia adversely impacts postoperative complications
following resection or transplantation in patients with primary liver tumors. Journal of
Gastrointestinal Surgery, 19(2), pp.272-281.
Vester-Andersen, M. and et.al., 2014. Mortality and postoperative care pathways after
emergency gastrointestinal surgery in 2904 patients: a population-based cohort
study. British journal of anaesthesia, 112(5), pp.860-870.
(Basch and et.al, 2014)(Pucher, Aggarwal and Darzi, 2014)(Sjöström and et.al, 2012)(Mavros
and et.al, 2014)(Valero III, and et.al, 2015)(Sjöström and et.al, 2012)(Underwood and et.al,
2014) (Angiolillo and et.al, 2012)(Pearse and et.al, 2014)(Shaw and et.al, 2013)(Collaborative,
2014)Baron, Kamath and McBane, 2013)(Birkmeyer and et.al, 2013)(Basch and et.al, 2014)