Learning from orthopaedic complications and adverse events in a district general hospital

INTRODUCTION: The aim of this study was to determine the learning derived from postoperative complications to reduce the risk of avoidable harm. METHODS: A retrospective review of a prospectively maintained local hospital registry of readmissions for complications was undertaken at a single district general hospital over a 10-year period (November 2014-November 2024). Learning points policy changes were monitored prospectively using audit to determine influence on clinical practice. RESULTS: There were 316 elective complications from 22,658 cases (1.4%) and 251 trauma complications from 15,862 cases (1.6%). There were 293 deaths out of the 38,520 total cases (0.76% mortality rate); of these, 16 occurred in elective surgery (0.07% mortality rate) and 241 trauma cases out of 15,852 (rate of 1.6%). The total number of elective cases requiring reoperation was 374. The cases from different hospitals accounted for 41%; there were 251 local trauma cases that required reoperation. The most frequent complication was implant dislocation in 201 cases, which was avoidable in one-third of cases due to technical issues. Most periprosthetic fractures were a late complication secondary to osteoporosis. Discussion of the care of complex cases enabled improved training packages and pathways to manage wound care, infection and the technical aspects of prosthetic joint implantation and fracture fixation for trainee surgeons. CONCLUSIONS: There is a significant resource implication for managing complications that originate from other hospitals. Monitoring complications and mortality helps improve practice and enable reproducible outcomes.