Impact of SAFEST intervention on first perioperative adverse events at two Portuguese hospitals

Background

In European hospitals, 8-12% of admitted patients experience adverse events (AE), with surgical AE being the most prevalent, contributing to disease burden and healthcare costs. Over half of potentially preventable surgical AE occur in the ward, driven by failures in clinical monitoring. Quality Improvement Collaboratives (QIC) hold promise in addressing these failures, yet real-world evidence remains limited. This study estimates the impact of a European QIC on AE incidence and time to first AE in high-risk elective surgeries.

Methods

Quasi-experimental before-and-after study with retrospective open cohort design, nested within the SAFEST project, conducted in Orthopaedics and General Surgery at two Portuguese tertiary university hospitals. Adult (≥18 years) patients undergoing elective surgery with adjusted mortality risk ≥1.0% were followed from surgery date to first perioperative AE, death, or 30 post-operative days. Pre-QIC period: June 2023-May 2024; QIC period: June 2024-November 2025. Outcomes include the incidence density and hazard ratio for the first AE, estimated using Poisson regression and Cox models.

Results

Preliminary results are presented. The cohort comprises 2,181 patients (866 pre-QIC; 1,315 during QIC), with a mean age of 60.5 years (SD 15.6), 57% female, and a high comorbidity burden (55% ASA III-IV; 43% obesity; 22% diabetes). Survival analyses are ongoing. Based on the literature, the estimated baseline AE incidence density is 9-13 per 100 person-months.

Conclusions

This study will provide real-world evidence on the impact of a QIC on reducing the perioperative AE burden in two Portuguese tertiary university hospitals, supporting clinical protocol optimisation, informing scale-up decisions for cost-effective surgical safety programmes, and strengthening perioperative safety surveillance.

Key messages

• By characterising ward-based AE incidence in a high-risk surgical population, this study generates actionable implementation evidence to improve patient safety for these tertiary university hospitals.

• Evidence from this study will inform scale-up of cost-effective perioperative safety interventions within the Portuguese NHS, supporting safer surgical care at the system level.