Retrospective analysis of preventable procedural adverse events (ICD-10 Y62-Y69) in the TriNetX network: a multiregional study before, during and after the COVID-19 pandemic.

Background: Healthcare-related procedural misadventures remain underreported despite decades of investment in patient safety. International Classification of Diseases, 10th Revision (ICD-10) codes Y62-Y69 capture defined preventable adverse events during medical and surgical care. This study aimed to examine temporal patterns in Y62-Y69-coded events using aggregated, precomputed data from the TriNetX Global Collaborative Network.

Methods: We conducted a retrospective observational study using deidentified electronic health records from the TriNetX platform, encompassing over 135 million patients aged 0-89 (years: 2016-2024). Incidence rates for Y62-Y69-coded events were analysed globally and across four regional networks, USA, Europe-Middle East-Africa (EMEA), Asia-Pacific (APAC) and Latin America (LATAM), with additional sensitivity analyses in cardiovascular (ICD-10: I00-I99) and oncological (ICD-10: C00-D49) cohorts. Temporal trends were explored descriptively using polynomial regression (for visual pattern illustration) and the Mann-Kendall trend test.

Findings: Globally, Y62-Y69 incidence rates increased from 0.04 to 0.09 per 100 000 patients between 2016 and 2024 (125% increase), with inflection in the early postpandemic phase. EMEA exhibited the steepest rise (414%), followed by APAC (225%). The USA showed a non-linear pattern detectable only through polynomial modelling. LATAM and APAC trends lacked statistical significance, likely due to high year-to-year variability. Sensitivity analyses in the disease-specific cohorts reflected similar patterns, reinforcing the consistency of findings.

Interpretation: This is the first global, real-world analysis of ICD-10 Y62-Y69-coded adverse events. The findings reveal a notable postpandemic escalation in procedural harm, underscoring the fragility of safety systems under operational stress. Regional heterogeneity and non-linear trajectories highlight the importance of locally tailored interventions and the need to reinvigorate global patient safety efforts.

Data Availability Statement: All data were extracted from the TriNetX Global Collaborative Network. Aggregated incidence rates and the R code used for statistical analysis are provided in online supplemental file 2.