A University of Auckland study revealed failures in recognising and responding to postoperative deterioration, rather than intraoperative technical errors, underpin most surgical complaints in New Zealand.

Published in BMJ Quality & Safety, the national retrospective cross-sectional study analysed publicly available investigation reports from the New Zealand Health and Disability Commissioner across all surgical specialties since 1998. Researchers used a large language model-assisted workflow to review 1,827 reports, identifying 650 that involved surgical care.

The most prominent complaint themes related to postoperative clinical management and monitoring, communication and informed consent and professional conduct or competence, said authors. Technical or procedural errors and those relating to medication were comparatively less common. Breaches most often involved failure to provide services with reasonable care and skill and deficiencies in informed consent, with notable variation between surgical specialties.

Researchers said complaints data provided a complementary lens on surgical safety, emphasising system-level issues rather than isolated technical failures. They concluded system priorities should focus on improving recognition and response to deterioration, strengthening handover and escalation pathways and reinforcing consent and communication processes.