# Detection of adverse events in older adults undergoing surgery using the IHI global trigger tool within the SURGE-Ahead project

## TL;DR

This study found that many older adults experience adverse events during surgery, with factors like age and frailty playing a role.

## Contribution

The study adapted the IHI Global Trigger Tool for older adults and identified new triggers for adverse events.

## Key findings

- 75.3% of older surgical patients experienced at least one adverse event.
- Intra/postoperative events and infections were the most common types of adverse events.
- Younger age, shorter surgery time, and no frailty were linked to fewer adverse events.

## Abstract

The aim of this study was to identify the number, type and severity of adverse events (AE) and the factors associated with the (non)-occurrence of AE in older surgical inpatients within the SURGE-Ahead project.

A retrospective chart review within a larger prospective observational study was conducted in three surgical departments of Ulm University Medical Center (trauma surgery, general surgery, urology). Patients undergoing inpatient elective or emergency surgery aged ≥ 70 years with an Identification of Seniors at Risk (ISAR) score ≥ 2 were included. A modified version of the Institute for Healthcare Improvement (IHI) Global Trigger tool (GTT) adapted to the geriatric cohort was utilized to identify AE during hospitalization and within 30 days after discharge. Binary logistic regression was conducted to identify factors associated with an adverse event-free treatment course.

Of 174 included participants, 131 (75.3%) had at least one AE. In total 348 AEs were identified, which can be expressed as 155.9 AE per 1000 patient days or 200.0 AE per 100 admissions. In most cases the AE resulted in temporary harm requiring intervention (58.9%). Intra-/postoperative AE (43.8%) and nosocomial infections (18.9%) occurred most frequently. Younger age, shorter operation time and absence of frailty were significantly associated with an AE-free treatment course (AUC 0.81).

A notable number of AE were detected in the study population. The addition of the triggers „new Impairment of cognition/vigilance, fluctuating confusion” and “electrolyte disturbances” enhanced the efficacy of the IHI GTT in the geriatric population. Age, frailty status and operation time might predict the need for geriatric co-management.

German clinical trials registry (Deutsches Register für klinische Studien, DRKS00030684), registered on 21st November 2022.

The online version contains supplementary material available at 10.1186/s12877-025-06833-5.