Predictive Power of the "Trigger Tool" for the detection of adverse events in general surgery: a multicenter observational validation study
Authors: Pérez Zapata Ana Isabel , Rodríguez Cuéllar Elías , de la Fuente Bartolomé Marta , Martín-Arriscado Arroba Cristina , García Morales María Teresa , Loinaz Segurola Carmelo , Giner Nogueras Manuel , Tejido Sánchez Ángel , Ruiz López Pedro , Ferrero Herrero Eduardo ,   The Research Collaboration Group, Zarco Pleguezuelos Antonio , Romero Simó Manuel , Caballero Bouza Albert , Parés Martinez David , Julián Ibáñez Juan Francés , Balibrea del Castillo José María , Morales Sevillano Xavier , Díaz-Zorita Aguilar Benjamín , Martín Román Lorena , Gomez Ruiz Marcos , Fernández Miguel Tamara , Cagigas Fernandez Carmen , Moreno Bargueiras Alejandro , Cano Valderrama Oscar , Alonso Rivera Daniel , Gutiérrez Samaniego María , Elia Guedea Manuela , Córdoba Diaz Elena , Gracia Solanas Jose Antonio , Bañuls Matoses Angela , Macero Ángel , Sánchez López Jose Daniel , Vaquero Pérez María Antonia , Rojo López Jose Alberto , Lima Pinto Francisca , Bra Insa Eneida , Rodríguez Prieto Ignacio , Padilla Zegarra Erlinda Daniela , Franco Chacon Mario , Memba Ikuga Robert , Jorba Martin Rosa , Alcaide Matas Fernando , Troncoso Pereira Paula , Soria Aledo Víctor , Pérez Guarinos Carmen Victoria , Genzor Rios Sixto , Dobón Rascón Miguel Ángel , Núñez Fernández Sandra , Valerias Domínguez Ernesta , García García Manuel , Zambrana Campos Vanesa , Rebasa Cladera Pere , Artés Caselles Mariano , Cea Soriano Matías , Gambí Pisonero Daniel , Jiménez de los Galanes Santos , Frutos Bernal Maria Dolores , Delegido García Ana , Gómez Pérez Beatriz , Montero Zorrilla Carlos , Cortés Climent Javier , Vallejo Bernad Cristina , Bustamante Mosquera Ruth , Blázquez María , Muriel López Jesús , García Pérez Juan Carlos , Ocaña Jiménez Juan , Paseiro Crespo Gloria , Pardo Martínez Cristina , García Nebreda María , Fernández Cebrián José María , Casanova Durán Virginia , Ferrer Márquez Manuel , Aguiló Lucía Javier 
Published: February 2022

Abstract
Background
In spite of the global implementation of standardized surgical safety checklists and evidence-based practices, general surgery remains associated with a high residual risk of preventable perioperative complications and adverse events. This study was designed to validate the hypothesis that a new “Trigger Tool” represents a sensitive predictor of adverse events in general surgery.

Methods
An observational multicenter validation study was performed among 31 hospitals in Spain. The previously described “Trigger Tool” based on 40 specific triggers was applied to validate the predictive power of predicting adverse events in the perioperative care of surgical patients. A prediction model was used by means of a binary logistic regression analysis.

Results
The prevalence of adverse events among a total of 1,132 surgical cases included in this study was 31.53%. The “Trigger Tool” had a sensitivity and specificity of 86.27% and 79.55% respectively for predicting these adverse events. A total of 12 selected triggers of overall 40 triggers were identified for optimizing the predictive power of the “Trigger Tool”.

Conclusions
The “Trigger Tool” has a high predictive capacity for predicting adverse events in surgical procedures. We recommend a revision of the original 40 triggers to 12 selected triggers to optimize the predictive power of this tool, which will have to be validated in future studies.