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Kiernan A, Boland F, Naughton P, Moneley D, Doyle F, Harkin DW. Varicose Vein Education and Informed coNsent (VVEIN) Study: A Randomized Controlled Pilot Feasibility Study. Ann Vasc Surg 2024; 106:142-151. [PMID: 38810723 DOI: 10.1016/j.avsg.2024.02.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 02/24/2024] [Accepted: 02/24/2024] [Indexed: 05/31/2024]
Abstract
BACKGROUND The primary aim of this study was to assess the feasibility of introducing a digital health education tool (dHET) for varicose vein surgery. METHODS This randomized, feasibility study allocated 40 patients, into dHET (n = 20) or standard consent (SC) (n = 20) groups. Primary outcomes were related to feasibility. Secondary outcomes were knowledge recall, anxiety, and satisfaction. RESULTS Recruitment and retention rates were 100% and 97.5%, respectively. Acceptability was also rated high, confirming feasibility. There was also no evidence of a difference between groups for early knowledge recall (14 [12-17] vs. 14 [11-16]; P = 0.72) or delayed (at 2 weeks) knowledge recall (15 [13-16] vs. 15 [13-16]; P = 0.89). The dHET module took significantly longer to complete compared to SC (13 min [12-18] vs. 9 min [8-12]; P < 0.01). However, the control group asked significantly more questions about the intended procedure (P = 0.03). There was no evidence of a difference between groups for patient anxiety or satisfaction. CONCLUSIONS This trial shows that the addition of a dHET is feasible and noninferior to SC. Digital consent provides a unique opportunity to promote patient education and autonomy for better shared decision making. It also offers better documentation of the consent process.
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Affiliation(s)
- Aoife Kiernan
- Strategic Academic Research (StAR) Programme, RCSI University of Medicine and Health Sciences, Dublin, Ireland; Department of Vascular Surgery, Bon Secours Health System, Dublin, Ireland.
| | - Fiona Boland
- Data Science Centre, School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Peter Naughton
- Department of Vascular Surgery, Bon Secours Health System, Dublin, Ireland; Department of Vascular Surgery, Beaumont Hospital, Dublin, Ireland
| | - Daragh Moneley
- Department of Vascular Surgery, Bon Secours Health System, Dublin, Ireland; Department of Vascular Surgery, Beaumont Hospital, Dublin, Ireland
| | - Frank Doyle
- Department of Health Psychology, School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Denis W Harkin
- Strategic Academic Research (StAR) Programme, RCSI University of Medicine and Health Sciences, Dublin, Ireland; Department of Vascular Surgery, Bon Secours Health System, Dublin, Ireland; Department of Medical Professionalism, RCSI University of Medicine and Health Sciences, Dublin, Ireland
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Kiernan A, Boland F, Moneley D, Doyle F, Harkin DW. Varicose Vein Education and Informed coNsent (VVEIN) study: a randomised controlled pilot feasibility study. Pilot Feasibility Stud 2023; 9:104. [PMID: 37349825 DOI: 10.1186/s40814-023-01336-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 06/07/2023] [Indexed: 06/24/2023] Open
Abstract
INTRODUCTION Doctors have a legal requirement and duty of care to ensure patients are enabled to make an informed decision about their treatment, including discussion of the benefits, risks and alternatives to a procedure. A patient-centred approach to consent has been firmly established in Ireland, and fundamental to this is the ability to engage in a dialogue that offers comprehensible information to patients. Telemedicine has revolutionised the way we can deliver care to patients in the modern era of computers, tablets, and smartphones, and its use has been rapidly expanded. Novel digital strategies to improve the informed consent process for surgical procedures have been increasingly under investigation over the last 10-15 years and may offer a low cost, accessible and tailored solution to consent for surgical interventions. Within vascular surgery, superficial venous interventions have been associated with a high number medicolegal claims and also represents an area within the specialty with rapidly evolving technology and techniques. The ability to communicate comprehensible information to patients has never been greater. Thus, the author's aim is to explore whether it is feasible and acceptable to deliver a digital health education intervention to patients undergoing endovenous thermal ablation (EVTA) to supplement the consent process. METHODS This is a prospective, single centre, randomised controlled, feasibility trial recruiting patients with chronic venous disease deemed suitable to undergo EVTA. Patients will be randomised to receive either standard consent (SC) or a newly developed digital health education tool (dHET). The primary outcome is feasibility; assessing the recruitment and retention rate of participants and assessing acceptability of the intervention. Secondary outcomes include knowledge retention, anxiety and satisfaction. This feasibility trial is designed to recruit 40 patients, which will allow for a moderate dropout rate. This pilot study will inform the authors of the appropriateness of an adequately powered multicentre trial. DISCUSSION To examine the role of a digital consent solution for EVTA. This may improve and standardise the consent dialogue with patients and may have the potential to reduce claims related to poor consent processes and disclosure of risks. ETHICAL COMMITTEE REFERENCE Ethical approval has been sought and received from both the Bon Secours Hospital and RCSI (202109017), on 14 May 2021 and 10 October 2021, respectively. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT05261412 , registered on 1 March 2022.
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Affiliation(s)
- Aoife Kiernan
- Strategic Academic Research (StAR) Programme, Royal College of Surgeons, Dublin, Ireland.
- Department of Vascular Surgery, Bon Secours Health System, Dublin, Ireland.
| | - Fiona Boland
- Data Science Centre, School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Daragh Moneley
- Department of Vascular Surgery, Bon Secours Health System, Dublin, Ireland
- Department of Vascular Surgery, Beaumont Hospital, Dublin, Ireland
| | - Frank Doyle
- Department of Health Psychology, School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Denis W Harkin
- Strategic Academic Research (StAR) Programme, Royal College of Surgeons, Dublin, Ireland
- Department of Vascular Surgery, Bon Secours Health System, Dublin, Ireland
- Department of Medical Professionalism, RCSI University of Medicine and Health Sciences, Dublin, Ireland
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Sen I, Choudhry A, Cherukuri SK, Mendes BC, Colglazier JJ, Shuja F, DeMartino RR, Rasmussen TE, Kalra M. An Analysis of Malpractice Litigation of Vascular Surgeons in Cases Involving Aortic Pathologies. Vasc Endovascular Surg 2023; 57:350-356. [PMID: 36537051 DOI: 10.1177/15385744221146389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/23/2023]
Abstract
OBJECTIVE The aim of this study was to analyze malpractice claims for aortic pathologies and to assess if there has been a change in rate of malpractice lawsuits with evolution of endovascular therapy. METHODS Malpractice lawsuits were individually screened and compiled from the Westlaw database from 2000 to 2017 through use of relevant search terms. Data were collected of allegations, diagnoses, and outcomes of each case and compared. RESULTS 268 unique cases were included in this study, with aneurysms (54%, n = 145) and dissection (35%, n = 94) making up the majority. There was a defendant verdict in 53% (n = 141), plaintiff verdict in 24% (n = 65), and settlements in 23% (n = 62) of lawsuits. Litigation was higher in the Midwest and Northeast. There was a gradual decline in litigation overall, however endovascular case numbers remained constant. There was negligible difference in the primary allegation underlying the litigation for various aortic pathologies, time to litigation and award between open and endovascular procedures. CONCLUSION The proportion of litigation for clinical negligence in endovascular cases amongst all vascular surgical lawsuits is increasing. As novel methods of endovascular therapy emerge, it is imperative that physicians remain vigilant to legal considerations to minimize malpractice risk.
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Affiliation(s)
- Indrani Sen
- Department of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Asad Choudhry
- Department of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Sai Kiran Cherukuri
- Department of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Bernardo C Mendes
- Department of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Jill J Colglazier
- Department of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Fahad Shuja
- Department of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Randall R DeMartino
- Department of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Todd E Rasmussen
- Department of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Manju Kalra
- Department of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN, USA
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Laukkavirta M, Blomgren K, Rautio R, Nikulainen V, Helmiö P. Compensated and non-compensated patient injury claims in internal carotid artery interventions in Finland, 2004-2017. Vascular 2022; 31:544-550. [PMID: 35089091 DOI: 10.1177/17085381211069294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Analysis of patient injuries offers possibilities for improving quality in patient care. The aim of this study was to identify errors and adverse events leading to patient injuries in the treatment of internal carotid artery stenosis (ICAS). METHODS A retrospective analysis was performed on data from Finnish patient injury claims and patient insurance center decisions in the treatment of ICAS, 2004-2017. Contributing factors to injury were identified and evaluated. RESULTS During the 14-year study period, 42 patient injury claims involving ICAS treatment were closed in Finland. One claim involved carotid artery stenting, and the other operations were carotid artery endarterectomies. Nine of the claims were compensated (seven for operations and two for evaluations). Fully trained vascular surgeons had carried out all the operations and evaluations. Stroke was the most common complaint in the claims (n = 12). Six of the compensated patients were symptomatic prior to the interventions. Injuries were related to errors in decision-making and patient selection in two cases. Four patients received compensation for nerve injury and three for stroke. No deaths were compensated as patient injuries. Most negative claim decisions were related to the injury having been unavoidable. CONCLUSION Compensated patient injuries involving the treatment of ICAS are rare but often serious and mostly involve open surgery. Patient injury claims provide a valuable source of information for recognizing errors in care and offer possibilities to improve patient safety.
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Affiliation(s)
- Minna Laukkavirta
- Department of Vascular Surgery, 60674Kanta-Häme Central Hospital, University of Turku, Hämeenlinna, Finland
| | | | - Riitta Rautio
- Department of Radiology, 60652Turku University Hospital, Turku, Finland
| | - Veikko Nikulainen
- Department of Vascular Surgery, 60652Turku University Hospital, University of Turku, Turku, Finland
| | - Päivi Helmiö
- Department of Vascular Surgery, 60652Turku University Hospital, University of Turku, Turku, Finland
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Ayre JR, Bazira PJ, Abumattar M, Makwana HN, Sanders KA. A new classification system for the anatomical variations of the human circle of Willis: A systematic review. J Anat 2021; 240:1187-1204. [PMID: 34936097 PMCID: PMC9119622 DOI: 10.1111/joa.13616] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 12/09/2021] [Accepted: 12/10/2021] [Indexed: 11/29/2022] Open
Abstract
The circle of Willis (CoW) is an anastomotic arterial network located on the base of the brain. Studies have shown that it demonstrates considerable anatomical variation in humans. This systematic review aimed to identify and catalogue the described anatomical variations of the CoW in humans to create a new, comprehensive variation classification system. An electronic literature search of five databases identified 5899 studies. A two‐phase screening process was performed, and studies underwent quality assessment. A total of 42 studies were included in the review. Data were extracted and circles were reconstructed digitally using graphics software. The classification system contains 82 CoW variations in five continuous groups. Group one contains 24 circles with one or more hypoplastic segments only. Group two contains 11 circles with one or more absent segments only. Group three contains 6 circles with hypoplastic and absent segments only. Group four contains 26 circles with one or more accessory segments. Group five contains 15 circles with other types of anatomical variation. Within each group, circles were subcategorised according to the number or type of segments affected. An original coding system was created to simplify the description of anatomical variations of the CoW. The new classification system provides a comprehensive ontology of the described anatomical variations of the CoW in humans. When used with the coding system, it allows the description and categorisation of recorded and unrecorded variants identified in past and future studies. It is applicable to current clinical practice and the anatomical community, including human anatomy education and research.
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Affiliation(s)
- James R Ayre
- Centre for Anatomical and Human Sciences, Hull York Medical School, University of Hull, Hull, UK
| | - Peter J Bazira
- Centre for Anatomical and Human Sciences, Hull York Medical School, University of Hull, Hull, UK
| | - Mohammed Abumattar
- Centre for Anatomical and Human Sciences, Hull York Medical School, University of Hull, Hull, UK
| | - Haran N Makwana
- Centre for Anatomical and Human Sciences, Hull York Medical School, University of Hull, Hull, UK
| | - Katherine A Sanders
- Centre for Anatomical and Human Sciences, Hull York Medical School, University of Hull, Hull, UK
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Lane J, Bhome R, Somani B. National trends and cost of litigation in UK National Health Service (NHS): a specialty-specific analysis from the past decade. Scott Med J 2021; 66:168-174. [PMID: 34743634 DOI: 10.1177/00369330211052627] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND AIMS Medical litigation claim and costs in UK are rising. This study aims to analyse the 10-year trend in litigation costs for individual clinical specialties in the UK from 2009/10 to 2018/19. METHODS Data were procured from National Health Service (NHS) Resolution. Number of claims, total litigation costs and cost per claim were ascertained for each financial year. The data collected also includes the number of claims and average amount per claim per speciality during the years 2009-2019 (2009/2010 to 2018/2019 financial years). RESULTS The total annual cost of NHS litigation is currently £3.6 billion(2018/2019). Damages make up the greatest proportion of costs(£1.5 billion). Surgical specialties have the greatest number of claims annually(2847) but Obstetrics has the greatest total litigation(£1.9 billion) and cost per claim(£2.6 million). Number of claims, total costs and cost per claim are significantly greater in 2018/2019 than in 2009/2010. CONCLUSIONS Addressing the issue of litigations is complex. Medically there are speciality specific issues that require attention, whilst some general measures are common to all: effective communication, setting realistic targets and maintaining a motivated, adequately staffed workforce. These, alongside legal reforms, may reduce the financial burden of increasing litigation on the NHS.
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Affiliation(s)
- Jenni Lane
- Department of Surgery, 7425University Hospitals Southampton NHS Trust, Southampton, UK
| | - Rahul Bhome
- Department of Surgery, 7425University Hospitals Southampton NHS Trust, Southampton, UK.,Faculty of Medicine, 7423University of Southampton, Somers Building, Southampton General Hospital, Southampton
| | - Bhaskar Somani
- Department of Surgery, 7425University Hospitals Southampton NHS Trust, Southampton, UK.,Faculty of Medicine, 7423University of Southampton, Somers Building, Southampton General Hospital, Southampton
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Laukkavirta M, Blomgren K, Väärämäki S, Nikulainen V, Helmiö P. Compensated Patient Injuries in the Treatment of Abdominal Aortic and Iliac Artery Aneurysms in Finland: A Nationwide Patient Insurance Registry Study. Ann Vasc Surg 2021; 80:283-292. [PMID: 34758376 DOI: 10.1016/j.avsg.2021.08.055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 08/06/2021] [Accepted: 08/12/2021] [Indexed: 01/27/2023]
Abstract
OBJECTIVES Patient injury claims data and insurance records provide detailed information on patient injuries. This study aimed to identify the errors and adverse events that led to patient injuries in vascular surgery for the treatments of abdominal aortic aneurysms (AAA) and iliac artery aneurysms (IAA) in Finland. The study also assessed the severity and preventability of the injuries. MATERIALS AND METHODS A retrospective analysis of Finnish Patient Insurance Centre's insurance charts of compensated patient injuries in the treatment of AAA and IAA. Records of all compensated patient injury claims involving AAA and IAA between 2004 and 2017 inclusive were reviewed. Contributing factors to injury were identified and classified. The injuries were assessed for their preventability by using the WHO Surgical Safety Checklist correctly. The degree of harm was graded by Clavien-Dindo classification. RESULTS Twenty-six patient injury incidents were identified in the treatment of 23 patients. Typical injuries involved delays in diagnosis or treatment, errors in surgical technique or injuries to adjacent anatomic organs. Three (13.0%) patients died due to patient injury. Two deaths were caused by delays in diagnosis of ruptured abdominal aortic aneurysm (RAAA) and the third death was due to missed diagnosis of post-operative myocardial infarction. Retained foreign material caused injuries to two (8.7%) patients. One (4.3%) patient had a severe postoperative infection. Three (13.0%) patients experienced an injury to an adjacent organ. One patient had a bilateral and another a unilateral above-the-knee amputation due to patient injury. Three injuries were considered preventable. Most harms were grade IIIb Clavien-Dindo classification in which injured patients required a surgical intervention under general anesthesia. CONCLUSIONS Compensated patient injuries involving the treatment of AAA and IAA are rare, but are often serious. Injuries were identified during all stages of care. Most injuries involved open surgical procedures.
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Affiliation(s)
- Minna Laukkavirta
- Department of Vascular Surgery, Kanta-Häme Central Hospital and University of Turku, Hämeenlinna, Finland.
| | | | - Suvi Väärämäki
- Centre for Vascular Surgery and Interventional Radiology, Tampere University Hospital and University of Tampere, Faculty of Medicine and Life Sciences, Tampere, Finland
| | - Veikko Nikulainen
- Department of Vascular Surgery, Turku University Hospital and University of Turku, Turku, Finland
| | - Päivi Helmiö
- Department of Vascular Surgery, Turku University Hospital and University of Turku, Turku, Finland
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Bryce Y, Emmanuel A, Agrusa C, Ziv E, Harnain C, Huq S, Martin ES. Acute limb ischemia in a cancer patient has high morbidity, high mortality, and atypical presentation: a tertiary cancer center's retrospective study. BMC Cancer 2021; 21:916. [PMID: 34388968 PMCID: PMC8361627 DOI: 10.1186/s12885-021-08659-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 07/27/2021] [Indexed: 11/10/2022] Open
Abstract
Background Acute Limb Ischemia (ALI) carries a high morbidity and mortality rate that is compounded in the cancer patient. Though it is a relatively uncommon event, it is of extremely high adverse impact and carries poor awareness among clinicians. Methods Retrospective review of electronic medical records was performed of cancer patients presenting with acute limb ischemia (ALI) to the tertiary cancer center’s urgent care center or as inpatient between January 1, 2014 and January 1, 2020. Results Out of the 29 cancer patients with ALI, 12 (41%) died within 3 month and 9 (31%) patients died within 1 months of ALI diagnosis. 65% had long term adverse outcome after ALI – 31% with death in 1 month, 2 (7%) with an amputation, 5 (17%) with lifestyle-limiting claudication, and 3 (10%) with subsequent wound ulceration or gangrene. Patients not eligible for standard of care (12 patients, 41%) (RR 2.33 95% CI [1.27–4.27], p < 0.01) and heparin administration ≥6 h from presentation (19 patients, 65%) (RR 2.81 [1.07–7.38], p = 0.04) were at increased risk of adverse outcome. Atypical/confounded presentation of ALI (13 patients, 45%) (RR 1.84 95% CI [1.03–3.29], p = 0.04), pulse exam not documented (12 patients, 41.4%) (RR 1.95 [95% CI [1.14–3.32], p = 0.01), and patients with services other than a vascular specialist initially consulted (8 patients, 27.6%) (RR 1.91 95% CI [1.27–2.87], p < 0.01) were significant risk factors for heparin administered ≥6 h from presentation. Conclusions ALI is devastating in cancer patients, with a high number presenting with atypical/confounded signs and symptoms which delays treatment. Heparin administered ≥6 h from presentation is associated with adverse outcome.
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Affiliation(s)
- Yolanda Bryce
- Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.
| | - Amoateng Emmanuel
- City University of NY (CUNY) School of Medicine, 160 Convent Avenue, Convent Ave, New York, NY, 10031, USA
| | - Christopher Agrusa
- New York Presbyterian Hospital Weill Cornell Medical Center, 525 East 68th Street Starr 8, New York, NY, 10065, USA
| | - Etay Ziv
- Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Christopher Harnain
- New York Presbyterian Hospital Weill Cornell Medical Center, 525 East 68th Street Starr 8, New York, NY, 10065, USA
| | - Samantha Huq
- New York Presbyterian Hospital Weill Cornell Medical Center, 525 East 68th Street Starr 8, New York, NY, 10065, USA
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Kowalczyk KA, Majewski A. Analysis of surgical errors associated with anatomical variations clinically relevant in general surgery. Review of the literature. TRANSLATIONAL RESEARCH IN ANATOMY 2021. [DOI: 10.1016/j.tria.2020.100107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Laukkavirta M, Blomgren K, Halmesmäki K, Nikulainen V, Helmiö P. Patient injuries in the treatment of superficial venous insufficiency registered in Finland between 2004 and 2017. Phlebology 2020; 36:260-267. [PMID: 33045906 DOI: 10.1177/0268355520964294] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES This study aimed to identify the unintended incidents that led to patient injuries (PIs) in the treatment of superficial venous insufficiency (SVI). METHODS PI claims filed with the Finnish Patient Insurance Centre between 2004 and 2017 involving SVI were reviewed. Factors contributing to PI were identified and classified. RESULTS Eighteen (13.2%) of 136 compensated PIs in the specialty of vascular surgery were related to SVI. Only 4.7% of 383 SVI claims were compensated. The incidence of PIs was 9.9 per 100 000 patients. Fifteen patients had open surgery (83.3%) and three (16.7%) endovenous treatment. Two (11.1%) patients had necrotising fasciitis, four (22.1%) had deep vein injuries and two (11.1%) had a permanent nerve injury. Two (11.1%) patients had retained endovenous material that required surgical removal. CONCLUSIONS PIs were identifiable during all stages of care, perioperative injuries related to open surgery being the most common.
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Affiliation(s)
- Minna Laukkavirta
- Department of Vascular Surgery, Kanta-Häme Central Hospital, University of Turku, Hämeenlinna, Finland
| | - Karin Blomgren
- Department of Otorhinolaryngology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | | | - Veikko Nikulainen
- Department of Vascular Surgery, Turku University Hospital, University of Turku, Turku, Finland
| | - Päivi Helmiö
- Department of Vascular Surgery, Turku University Hospital, University of Turku, Turku, Finland
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Clinical Negligence Claims Against Vascular Surgery in the United Kingdom: An Observational Study. Ann Vasc Surg 2020; 70:549-554. [PMID: 32946996 DOI: 10.1016/j.avsg.2020.09.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 09/02/2020] [Accepted: 09/03/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Claims for clinical negligence awarded to patients and their families are on the increase. The annual "cost of harm" is approximately £7-9 billion in the United Kingdom. In 2017, the National Health Service (NHS) resolution service reported that they mediated more claims than in their entire history. Vascular surgery is a specialty with a disproportionately higher number of claims for clinical negligence. The aim of this observational study was to review the trends of clinical negligence claims in vascular surgery within the United Kingdom. The costs and the primary cause for the complaint were evaluated. METHODS A retrospective observational study was performed. Clinical negligence claims in vascular surgery between the financial years of April 2005/2006 to April 2018/2019 were requested from NHS resolution under the Freedom of Information Act. Data were provided on November 8, 2019. All data were anonymized, and any categories containing fewer than five claims were removed to protect the identity of claimants. RESULTS Over the 13-year period, 1,189 claims in vascular surgery were identified, with the annual mean (range) being 91 (20-134) claims per year. Of 1,189 claims, 875 (74%) are closed with payments made to the claimants. The mean annual total payment was £10,015,373. Delay in treatment was the most common cause for litigation claims in vascular surgery with 157 closed claims costing £33,255,248 over the 13-year period. Lower limb amputation was the most common primary injury claim with 140 closed cases but had a larger financial cost at £64,155,969. CONCLUSIONS Clinical negligence claims in vascular surgery within the United Kingdom have been increasing steadily over the last 13 years and with a changing claims culture is expected to continue. The most common cause for claims with damages paid was delay in treatment, and lower limb amputation was the most common injury suffered. Improved consent, better communication with patients, and a higher surgical skill level could significantly reduce the number of future claims.
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Laukkavirta M, Nikulainen V, Blomgren K, Helmiö P. Patient Injuries in Treatment of Peripheral Arterial Disease in Finland: Review of National Patient Insurance Charts. Ann Vasc Surg 2020; 66:225-232. [DOI: 10.1016/j.avsg.2019.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 12/04/2019] [Accepted: 12/06/2019] [Indexed: 10/25/2022]
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The Consequences of Negligence Claims in Arterial Surgery - An Analysis of Two Periods with an Increasing Use of Endovascular Treatment. Eur J Vasc Endovasc Surg 2019; 58:771-776. [PMID: 31530500 DOI: 10.1016/j.ejvs.2019.06.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 06/18/2019] [Accepted: 06/21/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Patient treatment within the Swedish medical service system can claim negligence injuries to the malpractice insurance review board and request financial compensation. The aim of this paper was to analyse the consequences of a negligence claim after arterial surgery between two periods with increasing use of endovascular treatment. METHODS This was a retrospective cohort study of the arterial surgery negligence claims from two three year periods 2005-2007 (Period A) and 2012-2014 (Period B) from the County Council's Mutual Insurance Company. The analysis was restricted to aortic, carotid, and lower limb arterial diseases. The magnitude of surgery for vascular diseases was obtained from the Swedish vascular register (Swedvasc). RESULTS The number of patients undergoing arterial procedures increased from 16 628 to 20 709 (p = .01). There was an increase of 54% in the number of negligence claims between the periods. In Period A, the number of compensated claims was 22 out of 83 (29%) and in Period B 60 out of 151 (41%) (p = .06). Patients treated for aortic disorders and peripheral arterial surgery received compensation with increasing frequency whereas carotid diseases decreased. Claimants treated for aortic disorders were compensated in four out of 23 (17%) and 21 out of 54 (39%) in the two periods (p = .07), and after lower limb arterial surgery in six out of 34 (18%) and in 24 out of 71 (34%) (p = .09). After carotid surgery the corresponding figures were 12 out of 26 (46%) and 14 out of 25 (46%) (p = .48). The increasing use of endovascular procedures (but not in carotid artery surgery) did not seem to influence the pattern of negligence claims. CONCLUSIONS Between the two three year periods there has been an increase in negligence claims but not in compensated ones. The increased use of endovascular procedures has not influenced the pattern of compensated negligence claims.
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Chan J, Oo S. Fourteen years of litigation claims in cardiothoracic surgery in the United Kingdom National Health Service. J Card Surg 2019; 34:754-758. [DOI: 10.1111/jocs.14124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 05/15/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Jeremy Chan
- Department of Cardiothoracic SurgeryMorriston HospitalSwansea UK
| | - Shwe Oo
- Department of Cardiothoracic SurgeryUniversity Hospital BristolBristol UK
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Gianesini S, Menegatti E, Sibilla MG, Neuhardt D, Maietti E, Tessari M, Zamboni P. Mini-invasive foam sclerotherapy-assisted ligation versus surgical flush ligation for incompetent sapheno-popliteal junction treatment. Phlebology 2019; 34:604-610. [PMID: 30808248 DOI: 10.1177/0268355519833229] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives Comparison of a flush sapheno-popliteal junction ligation versus a mini-invasive foam sclerotherapy-assisted ligation. Methods Forty-eight chronic venous disease patients underwent sapheno-popliteal junction flush ligation (group A). Forty-one patients underwent small saphenous vein ligation by means of mini-invasive incision with foam sclerotherapy of the popliteal stump (group B). Results At 4.1 ± 3.3 years mean follow-up, sapheno-popliteal junction recurrence was detected in four patients of group A (4/48; 8.3%) and in two cases of group B (3/41; 7.3%) ( P= ns). Mean procedural time was 36 ± 11 minutes versus 21 ± 6 minutes ( p<0.0001). A mild post-operative paresthesia lasting more than 24 h was reported in 6.3% (3/48) of group A versus 2.4% (1/41) ( p<0.009) of group B. At one-year check-up, Aberdeen Varicose Vein Questionnaire significantly improved in both groups with no significant difference between group A and B. Conclusions Foam-assisted mini-invasive sapheno-popliteal ligation represents a time and clinical-effective option, associated with a decrease in post-operative paresthesia risk.
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Affiliation(s)
- Sergio Gianesini
- Vascular Diseases Center - Translational Surgery Unit, University of Ferrara, Ferrara, Italy
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Erica Menegatti
- Vascular Diseases Center - Translational Surgery Unit, University of Ferrara, Ferrara, Italy
| | - Maria Grazia Sibilla
- Vascular Diseases Center - Translational Surgery Unit, University of Ferrara, Ferrara, Italy
| | - Diana Neuhardt
- Comprehensive Interventional Care Centers, Phoenix, AZ, USA
| | - Elisa Maietti
- Center for Clinical Epidemiology, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Mirko Tessari
- Vascular Diseases Center - Translational Surgery Unit, University of Ferrara, Ferrara, Italy
| | - Paolo Zamboni
- Vascular Diseases Center - Translational Surgery Unit, University of Ferrara, Ferrara, Italy
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Faccini FP, Ermini S, Franceschi C. CHIVA to treat saphenous vein insufficiency in chronic venous disease: characteristics and results. J Vasc Bras 2019; 18:e20180099. [PMID: 31191629 PMCID: PMC6542318 DOI: 10.1590/1677-5449.009918] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 11/28/2018] [Indexed: 02/06/2023] Open
Abstract
There is considerable debate in the literature with relation to the best method to treat patients with chronic venous disease (CVD). CHIVA is an office-based treatment for varicose veins performed under local anesthesia. The aim of the technique is to lower transmural pressure in the superficial venous system and avoid destruction of veins. Recurrence of varicosities, nerve damage, bruising and suboptimal aesthetic results are common to all treatments for the disease. This paper evaluates and discusses the characteristics and results of the CHIVA technique. We conclude that CHIVA is a viable alternative to common procedures that is associated with less bruising, nerve damage, and recurrence than stripping saphenectomy. The main advantages are preservation of the saphenous vein, local anesthesia, low recurrence rates, low cost, low pain, and no nerve damage. The major disadvantages are the learning curve and the need to train the team in venous hemodynamics.
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Affiliation(s)
- Felipe Puricelli Faccini
- Cirurgia Vascular, Hospital Moinhos de Vento, Porto Alegre, RS, Brasil.
- Instituto de Cardiologia, Porto Alegre, RS, Brasil.
| | | | - Claude Franceschi
- Centre Marie Thérèse, Hôpital Saint Joseph Paris, Paris, France.
- Hôpital Salpêtrière, Paris, France.
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Yang GK, Parapini M, Gagnon J, Chen JC. Comparison of cyanoacrylate embolization and radiofrequency ablation for the treatment of varicose veins. Phlebology 2018; 34:278-283. [PMID: 30114987 DOI: 10.1177/0268355518794105] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To review clinical outcomes of varicose vein patients treated with cyanoacrylate embolization and radiofrequency ablation at our institution. METHODS A retrospective review of patients who underwent cyanoacrylate embolization and radiofrequency ablation during a three-year period. Patient records were reviewed to assess demographics, location and severity of disease, treatment details and outcome at short- and mid-term follow-ups. Outcome parameters included treatment success and complications. RESULTS Between January 2014 and December 2016, 335 patients with 476 veins were treated with either cyanoacrylate embolization (n = 148) or radiofrequency ablation (n = 328) at the Vancouver General Hospital Vascular Surgery Vein Clinic. The average age of patients were 57 ± 1 years with the majority being female (78%) and an average BMI of 24.8 ± 0.5. CEAP classes were 2 (49%), 3 (26%), 4a (22%) and >4b (3%). Of the veins treated with cyanoacrylate embolization, the vein types were as follows: 76% were great saphenous vein, 16% were small saphenous vein, 5% were anterior accessory great saphenous vein and 1.4% were perforator veins. The vein types for radiofrequency ablation were 88%, 9%, 3% and 0%, respectively. The average amount of cyanoacrylate embolization delivered for great saphenous vein treatment was 1.8 ± 0.1 ml with a treatment length of 43 ± 1 cm. Subgroup comparison was done for great saphenous vein segments. Treatment success was 100% in cyanoacrylate embolization and 99% in radiofrequency ablation. Superficial phlebitis was the most common complication noted at mid-term follow-up in 5% of cyanoacrylate embolization and 16% of radiofrequency ablation treatments (P < 0.05). One patient in each group had asymptomatic proximal thrombus extension treated with anticoagulation for 2-3 weeks. Three superficial infections from glue clumps were noted in the cyanoacrylate embolization group requiring excision and drainage. Five patients in the radiofrequency ablation group had persistent numbness and one wound complications at the access site. CONCLUSION Cyanoacrylate embolization offers equivalent success rates with lower mid-term complication rates as radiofrequency ablation.
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Affiliation(s)
- Gary K Yang
- Division of Vascular Surgery, University of British Columbia, Vancouver, Canada
| | - Marina Parapini
- Division of Vascular Surgery, University of British Columbia, Vancouver, Canada
| | - Joel Gagnon
- Division of Vascular Surgery, University of British Columbia, Vancouver, Canada
| | - Jerry C Chen
- Division of Vascular Surgery, University of British Columbia, Vancouver, Canada
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Phair J, Trestman EB, Skripochnik E, Lipsitz EC, Koleilat I, Scher LA. Why Do Vascular Surgeons Get Sued? Analysis of Claims and Outcomes in Malpractice Litigation. Ann Vasc Surg 2018; 51:25-29. [DOI: 10.1016/j.avsg.2018.02.024] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Revised: 02/21/2018] [Accepted: 02/22/2018] [Indexed: 11/16/2022]
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Howard A, Zhong J, Scott J. Are multidisciplinary teams a legal shield or just a clinical comfort blanket? Br J Hosp Med (Lond) 2018; 79:218-220. [DOI: 10.12968/hmed.2018.79.4.218] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Anthony Howard
- NIHR Clinical Lecturer in Trauma and Orthopaedics, Department of Orthopaedic and Trauma Science, Leeds General Infirmary, Leeds LS1 3EX
| | - Jim Zhong
- NIHR Academic Clinical Fellow in Radiology, Department of Diagnostic and Interventional Radiology, Leeds General Infirmary, Leeds
| | - Julian Scott
- Consultant Vascular Surgeon, Department of Vascular Surgery, Leeds University, Leeds
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Abstract
ZusammenfassungEinführung: Zur Behandlung der Stammvarikose mit dem VenaSeal™ Closure-System ist eine Narkoseform oder Tumeszenzanästhesie nicht erforderlich. Ebenfalls kann auf das Tragen von Kompressionsstrümpfen verzichtet werden. Über die Anwendung, erste Erfahrungen und 2 Jahresergebnisse wird berichtet.Material und Methode: In der Zeit von März 2012 bis Mai 2014 wurden 218 Patienten an 274 Stammvenen mit dem VenaSeal™ Closure-System therapiert. Doppler und Duplexuntersuchungen erfolgten nach 7 Tagen, 6 Wochen, 1 Jahr und 2 Jahren. Erhoben wurde die Verschluss- und Komplikationsrate, der visuelle analoge Schmerz-Score und der Venous Clinical Severity Score(VCSS).Ergebnisse: Nachuntersucht wurden 227 Stammvenen der Vena saphena magna (VSM) und 24 Stammvenen der Vena saphena parva (VSP). Die Verschlussrate der VSM betrug 99,5 % (n= 227) nach 7 Tagen, 96,5 % nach 6 Wochen (n= 172), 93,4 % nach 1 Jahr (n= 61) und 100 % nach 2 Jahren (n= 20). Die Verschlussrate der VSP betrug jeweils 100 % nach 7 Tagen (n= 24), 6 Wochen (n= 12) und nach 1 Jahr (n=4). Majorkomplikationen traten nicht auf. Als Minorkomplikationen traten nach Behandlung der Vena saphena magna inflammatorische Reaktionen bei 44 Beinen und Phlebitiden bei 32 Beinen auf. Der Pain Score entwickelte sich unter der Behandlung von 1,4 auf 1,5 (3. Tag), 2,1 (5. Tag), 1,6 (10. Tag), 0,2 (4 Wochen) auf 0,1 (6 Wochen). Der VCSS betrug präoperativ 4,4 und sank auf 2,9 (7. Tag), 2,1 (6 Wochen) auf 1,8 (1 und 2 Jahr)Diskussion: Die VenaSeal™ Closure-Behand-lung der Stammvarikose ist sicher und effektiv. Die Ergebnisse sind vergleichbar denen der thermischen Ablationsverfahren. Ohne die Anwendung der Tumeszenz-Anästhesie haben die Patientin deutlich weniger Beschwerden im Vergleich zu den thermischen Ablationsverfahren, sowohl während der Behandlung, als auch postoperativ.
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Bokshan SL, Ruttiman R, Eltorai AE, DePasse JM, Daniels AH, Owens BD. Factors Associated With Physician Loss in Anterior Cruciate Ligament Reconstruction Malpractice Lawsuits. Orthop J Sports Med 2017; 5:2325967117738957. [PMID: 29201926 PMCID: PMC5697590 DOI: 10.1177/2325967117738957] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Anterior cruciate ligament (ACL) reconstruction is among the most common orthopaedic procedures, with its incidence doubling over the past decade. To date, no studies have analyzed litigation after ACL reconstruction. PURPOSE To characterize the causes of malpractice litigation after ACL reconstruction. STUDY DESIGN Cross-sectional study. METHODS A retrospective review of malpractice lawsuits after ACL reconstruction was performed using VerdictSearch, a large legal claims database encompassing nearly 180,000 legal cases, from February 1988 to May 2015. Settlement rates and physician loss rates were calculated along with 95% CIs for each complication type, and analysis of variance was used to compare all indemnity payments. RESULTS Of a total 30 lawsuits, 5 (16.7%) settled out of court. The 3 most common complications leading to litigation were prolonged pain (n = 5, 16.7%), infection (n = 5, 16.7%), and malpositioned graft (n = 5, 16.7%). Of the 25 cases that went to court, 8 (32.0%) ended in favor of the plaintiff (physician loss). Damage to a neurovascular structure resulted in the highest indemnity payment (mean, $2,012,926 ± $1,076,530; P = .021). Lawsuits for which pain or loss of range of motion was the only complication were significantly more likely to end in a physician victory (P = .04) and lower indemnity payments ($87,500 vs $678,715, respectively). Cases that involved a surgical technical error were more likely to result in a physician loss (P = .01), with malpositioned grafts having a significantly higher loss rate than average (75% vs 32%, respectively). CONCLUSION After ACL reconstruction, physicians are more likely to win malpractice suits if pain or limited range of motion is the only complaint and less likely to win if a surgical error was alleged. These findings may help to set patient expectations and provide adequate guidance during the informed consent process.
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Affiliation(s)
- Steven L. Bokshan
- Department of Orthopaedics, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Roy Ruttiman
- Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Adam E.M. Eltorai
- Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - J. Mason DePasse
- Department of Orthopaedics, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Alan H. Daniels
- Division of Spine Surgery, Department of Orthopaedics, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Brett D. Owens
- Division of Sports Medicine, Department of Orthopaedics, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
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Reclamaciones médico-legales y cirugía de varices. Peritajes de un cirujano vascular durante 25 años. ANGIOLOGIA 2016. [DOI: 10.1016/j.angio.2015.10.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Learning from lawsuits: Ten-years of NHS litigation authority claims against 11 surgical specialities in England. Surgeon 2016; 16:27-35. [PMID: 27161098 DOI: 10.1016/j.surge.2016.03.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Revised: 03/25/2016] [Accepted: 03/29/2016] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Medico-legal claims are a drain on NHS resources and promote defencive practice. The litigious burden of surgery in England has not been previously described. This paper describes trends over ten years of claims made against the NHS across 11 surgical specialities. MATERIALS AND METHODS Data were requested for all claims received by the NHS Litigation Authority (NHSLA) from 2004 to 2014. Surgical specialities included cardiothoracic, general, neurosurgery, obstetric, oral and maxillofacial (OMFS), orthopaedic, otorhinolaryngology, paediatric, plastic, urology and vascular surgery. A literature review of peer-reviewed publications was performed with search terms 'NHSLA' and 'Surgery'. RESULTS The NHS paid out approximately £1.5 billion across 11 surgical specialities from 2004 to 2014. Orthopaedic, obstetric and general surgery received the largest number of claims per year, and paediatric surgery the least. The mean time from registration of claim with the NHSLA to settlement was 25.5 months (range 17.8 months-35 months). Neurosurgery was responsible for the highest average amount paid per claim, and OMFS the lowest. Failure/delay in treatment and/or diagnosis and failure to warn/adequately consent were the three leading types of claim. 806 never events were successfully claimed for during the ten-year period. DISCUSSION AND CONCLUSION Sharing information and good practice should be a priority for surgical professionals. Lessons learnt from medico-legal claims are transferrable in strategic planning. This pan-speciality report has demonstrated considerable burden on the NHS and should promote improvement in practice on an individual level in addition to providing systems based recommendations to NHS and international organisations.
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Does defensive medicine change the behaviors of vascular surgeons? A qualitative review. BIOMED RESEARCH INTERNATIONAL 2015; 2015:170692. [PMID: 26495285 PMCID: PMC4606144 DOI: 10.1155/2015/170692] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 04/18/2015] [Indexed: 11/18/2022]
Abstract
Although in literature few successful claims have been shown in comparison with other medical specialties such as gynaecology and orthopaedics, vascular surgery is included among high-risk specialties. The high-risk of receiving medical claims may lead vascular surgeons to practice defensive medicine, as is normal in several other areas of clinical practice. No studies are available to our knowledge of the incidence of defensive medicine in the field of vascular surgery. Taking into consideration the scarce amount of information, the authors provide a critical discussion regarding the application of defensive medicine behaviour among vascular surgeons.
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Di Cristofaro L, Ruffolo C, Pinto E, Massa M, Antoniutti M, Cagol M, Massani M, Alfieri R, Costa A, Bassi N, Castoro C, Scarpa M. Complications after surgery for colorectal cancer affect quality of life and surgeon-patient relationship. Colorectal Dis 2014; 16:O407-19. [PMID: 25155523 DOI: 10.1111/codi.12752] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Accepted: 05/26/2014] [Indexed: 12/19/2022]
Abstract
AIM This multicentric prospective study aimed to investigate how postoperative complications after surgery for colorectal cancer affect patients' quality of life and satisfaction with care. METHOD One hundred and sixteen patients operated on for colorectal cancer were enrolled in this study. Patients answered three questionnaires about generic (EORTC QLQ-C30) and disease-specific (EORTC QLQ-CR29) quality of life and treatment satisfaction (EORTC IN-PATSAT32) at the time of admission and at 1 and 6 months after surgery. Non-parametric tests and linear multiple regression models were used for statistical analysis. RESULTS Twelve patients had complications requiring further surgery (anastomotic leakage, abdominal bleeding, abdominal wall sepsis, wound infection). Patients with complications that required surgery reported a worse score of physical function, emotional function and anxiety than patients without such complications 1 month after surgery. These patients judged their general satisfaction with the quality of care and doctors' interpersonal skills, technical skills, information provision and availability to be worse than in patients without such complications. The presence of postoperative psychiatric complications and anastomotic leakage were independent predictors of quality of life (β = -0.30, P = 0.004, and β = -0.42, P < 0.001). CONCLUSION In patients undergoing surgery for colorectal cancer, complications requiring any kind of surgical management significantly affected patients' perception of all doctor-related items suggesting an impairment of the entire surgeon-patient relationship. Convincing patients that 'zero risk' cannot be achieved in surgical practice is therefore a priority.
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Affiliation(s)
- L Di Cristofaro
- General Surgery Unit, Nottola Hospital, Montepulciano, Italy
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Mosedale T, Nepogodiev D, Fitzgerald JEF, Bhangu A. Causes and costs of a decade of litigation following emergency appendectomy in England. World J Surg 2014; 37:1851-8. [PMID: 23354921 DOI: 10.1007/s00268-013-1907-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND There has been recent interest in the delayed and nonoperative management of appendicitis. The present study assessed the causes and costs of litigation against surgeons following emergency appendectomy, with an emphasis on claims relating to preoperative management. MATERIALS AND METHODS Data were obtained from the English NHS Litigation Authority for claims relevant to appendectomy between 2002 and 2011. Two authors independently extracted data and classified it against predetermined criteria. RESULTS Successful litigation occurred in 66 % of closed cases (147/223) with a total payout of £8.1 million. There were 24 claims against organizational operating room delays (9 % of total) and 27 against delayed diagnosis (10 %), with respective success rates of 70 and 68 %. From 21 claims relating to damage to fertility, nine were due to either delayed diagnosis or organizational operating room delays. Misdiagnosis was the second most common cause for litigation (16 %), but it had the lowest likelihood of success (49 %). Faulty surgical technique was the most common reason for litigation (39 %), with a 70 % likelihood of success. Of eight claims related to fatality, one was due to unacceptable preoperative delay leading to preventable perforated appendicitis. The overall highest median payouts were for claims of damage to fertility (£52,384), operating list delays (£44,716), and delayed diagnosis (£42,292). CONCLUSIONS There were significant medicolegal risks surrounding delays related to access to operating lists and diagnosis. Whereas future evidence regarding the safety of delayed appendectomy may provide scientific defense against these claims, the present study provides evidence of the current medicolegal risk to surgeons following delayed treatment of appendicitis.
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Affiliation(s)
- Thomas Mosedale
- Central Manchester University Hospitals NHS Trust, Manchester, UK
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Professional Liability Claims in Vascular Surgery Practice. Ann Vasc Surg 2014; 28:324-9. [DOI: 10.1016/j.avsg.2012.11.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Revised: 10/09/2012] [Accepted: 11/14/2012] [Indexed: 11/23/2022]
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Medical liability insurance claims after treatment of varicose veins. Phlebology 2013; 29:293-7. [DOI: 10.1177/0268355512474251] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2012] [Indexed: 11/15/2022]
Abstract
Objective: Since insight into the reason for filing claims after treatment of varicose veins of the lower extremity might help prevent future claims, we determined the incidence of and reasons for medical liability insurance claims after such treatments in the Netherlands. Method: We performed a retrospective review of all medical liability insurance claims after varicose vein treatment handled by MediRisk between January 1993 and December 2007. Results: A total of 144 claims were filed of which 104 were closed by the end of the study period. Nerve injury ( n = 28), skin necrosis following sclerotherapy ( n = 17), deep vein injury ( n = 11) and insufficient communication ( n = 9) accounted for more than 60% of all claims. Claims were equally distributed among registrars and consultants. Some 41 of the 104 closed claims were accepted. In 27 of the accepted cases, the physician had obviously failed in providing the care as expected from a medical practitioner allowed to perform these treatments. The majority of these 27 claims were due to injury of nerves ( n = 11) or deep veins ( n = 9). Conclusion: The incidence of claims after treatment of varicose veins in the Netherlands is low. Proper knowledge of anatomy and adequate communication, along with the introduction of less invasive treatments might prevent future claims.
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Lawson J, Gauw S, Van Vlijmen C, Pronk P, Gaastra M, Mooij M, Wittens CHA. Sapheon: the solution? Phlebology 2013; 28 Suppl 1:2-9. [DOI: 10.1177/0268355513475970] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Less invasive endovenous techniques have been shown to be as effective as open surgery in the treatment of varicose veins. Furthermore, they cause less postoperative bruising and pain and enable early return to normal activities and work. Tumescent anaesthesia is safe and obviates complications of general or spinal anaesthesia. Drawbacks are a steep learning curve and painful administration during treatment. Tumescentless techniques like Clarivein™ or VenaSeal™ Sapheon Closure System are recently under investigation. Short-term results of VenaSeal™ are comparable with thermal ablation. The procedure is safe without serious adverse events. Perioperative pain and patient discomfort with this tumescentless approach is minimal but postoperative recovery is temporarily hindered by thrombophlebitis in 14–15 % of patients. One-year results in a small feasibility study has demonstrated durable closure at this endpoint. No longer-term results are available. A randomized control trial between VenaSeal™ and Covidien ClosureFast™ is in a preparatory phase.
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Affiliation(s)
- J Lawson
- Skin and Vein Clinic Oosterwal, Alkmaar
- Department of Vascular Surgery MUMC+, Maastricht, The Netherlands
| | - S Gauw
- Skin and Vein Clinic Oosterwal, Alkmaar
| | | | - P Pronk
- Skin and Vein Clinic Oosterwal, Alkmaar
| | - M Gaastra
- Skin and Vein Clinic Oosterwal, Alkmaar
| | - M Mooij
- Skin and Vein Clinic Oosterwal, Alkmaar
| | - C H A Wittens
- Department of Vascular Surgery MUMC+, Maastricht, The Netherlands
- Department of Vascular Surgery University Hospital Aachen, Aachen, Germany
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Anwar MA, Lane TRA, Davies AH, Franklin IJ. Complications of Radiofrequency Ablation of Varicose Veins. Phlebology 2012; 27 Suppl 1:34-9. [DOI: 10.1258/phleb.2012.012s21] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Radiofrequency ablation (RFA) has become a valued weapon in the phlebologist's armoury. It offers ease of use and reproducibility with good outcomes. However, as with all interventions, complications arise. In this review we examine the complications inherent with RFA and their relative risk, with their avoidance measures if available. Overall, we find that RFA offers a very safe procedure with rare severe complications.
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Affiliation(s)
- M A Anwar
- Academic Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, 4 North, Charing Cross Hospital, London, UK
| | - T R A Lane
- Academic Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, 4 North, Charing Cross Hospital, London, UK
| | - A H Davies
- Academic Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, 4 North, Charing Cross Hospital, London, UK
| | - I J Franklin
- Academic Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, 4 North, Charing Cross Hospital, London, UK
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Insurance Claims after Vascular Surgery in Sweden. Eur J Vasc Endovasc Surg 2011; 42:498-505. [DOI: 10.1016/j.ejvs.2011.04.026] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2010] [Accepted: 04/17/2011] [Indexed: 11/17/2022]
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Gulati A, Herd MK, Nimako M, Anand R, Brennan PA. Litigation in National Health Service oral and maxillofacial surgery: review of the last 15 years. Br J Oral Maxillofac Surg 2011; 50:385-8. [PMID: 21788098 DOI: 10.1016/j.bjoms.2011.06.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2011] [Accepted: 06/20/2011] [Indexed: 12/01/2022]
Abstract
Litigation claims are increasing in medicine but we know of little detailed analysis of those published concerning oral and maxillofacial surgery (OMFS) despite information being freely available from the NHS Litigation Authority (NHSLA) under the Freedom of Information Act. We obtained information from the NHSLA on clinical and non-clinical negligence claims in OMFS from April 1995 to August 2010, and analysed the data with outcomes and a further breakdown of subspecialty. During the period 318 claims relating to OMFS were registered. As expected, because of the high volume of patients treated, the highest number of claims related to dentoalveolar surgery and minor oral surgery. The total amount paid out was in excess of £5 million, and the highest claim (more than £300,000) during the period was for misdiagnosis of an oral cancer. Litigation in OMFS is increasing, as is the number of cases that necessitate compensation by the NHSLA. We discuss the trends and implications.
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Affiliation(s)
- A Gulati
- Maxillofacial Unit, Queen Alexandra Hospital, Portsmouth PO6 3LY, UK
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Establishing the Learning Curve for a Tunneled Dialysis Catheter Placement. J Vasc Access 2011; 13:86-90. [DOI: 10.5301/jva.5000006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2011] [Indexed: 11/20/2022] Open
Abstract
Purpose To determine how many procedures a surgical trainee requires before they are able to place a tunneled double-lumen dialysis catheter safely on their own. Methods Surgical trainees unfamiliar with the procedure received a pre-operative briefing in which we explained 1) why, how, and in what particular order each operational step should be executed and 2) what the possible pitfalls/complications are. Next, an experienced surgeon demonstrated the procedure with the trainee scrubbed-in as their assistant. The trainee then performed all successive procedures, while the supervising surgeon acted as a silent observer and intervened only when an error was made. We recorded all errors as well as near misses and noted if they were severe, recurrent or unanticipated. At least three procedures were required but training was continued until less than three errors were made. Results Ten trainees were included in the study. On average, a trainee made 11.9 mistakes during 3.4 procedures in a time span of 28.2 days. Only three trainees performed their last procedure flawlessly. The number of errors decreased exponentially from the first procedure onwards (P<.001). A statistically significant correlation was found between the number of mistakes and the number of days since the last procedure (P<.035). Unanticipated errors most frequently involved erroneous fluoroscopy interpretation, flushing with blood-contaminated saline, and incorrect volume injection for the heparin lock. Conclusions A theoretically well-prepared surgical trainee should be able to perform the placement of a tunneled dialysis catheter safely after four procedures. Training is more efficient when procedures follow each other quickly.
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Does an Information Leaflet about Surgical Site Infection (SSI) Improve Recollection of Information and Satisfaction of Patients? A Randomized Trial in Patients Scheduled for Digestive Surgery. World J Surg 2011; 35:1202-11; discussion 1212-3. [DOI: 10.1007/s00268-011-1054-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Doganci S, Yildirim V, Demirkilic U. Does Puncture Site Affect the Rate of Nerve Injuries Following Endovenous Laser Ablation of the Small Saphenous Veins? Eur J Vasc Endovasc Surg 2011; 41:400-5. [DOI: 10.1016/j.ejvs.2010.11.029] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2010] [Accepted: 11/28/2010] [Indexed: 11/30/2022]
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Gandhi A, Froghi F, Shepherd AC, Shalhoub J, Lim CS, Gohel MS, Davies AH. A Study of Patient Satisfaction Following Endothermal Ablation for Varicose Veins. Vasc Endovascular Surg 2010; 44:274-8. [DOI: 10.1177/1538574410363834] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: To evaluate patient satisfaction following endothermal ablation for varicose veins (VVs). Methods: A 12-question survey was sent to consecutive patients treated with endothermal ablation—questions related to preprocedure symptoms, recurrence, further treatments, and patient satisfaction. Results: Questionnaires sent a median 12 (range 6-22) months postintervention were returned by 177 (60.0%) of 295 patients; 63 (35.6%) of 177 received treatment for recurrent VVs. Preintervention symptoms included aching (141 [79.7%] of 177), swelling (86 [48.6%] of 177), and heaviness (72 [40.7%] of 177). Improvements in preoperative symptoms were reported by 82.5% (146 of 177). Postintervention recurrence was reported by 87 (49.4%) of 177; 61 (70.1%) of 87 reported a few recurrent varicosities only. Further treatment was required by 11 (6.2%) of 177; 79 (44.6%) of 177 of patients reported no complications. The majority (151 [85.8%] of 176) were satisfied with their treatment. In all, 16 (25.4%) of 62 of patients treated for recurrent VVs were dissatisfied versus 9 (7.9%) of 114 of those with primary VVs (P = .0026). Conclusions: The majority of patients are satisfied with results following endothermal ablation. Dissatisfaction may be more likely following treatment for recurrent VVs.
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Affiliation(s)
| | | | | | - Joseph Shalhoub
- Imperial Vascular Unit, Imperial College London, United Kingdom,
| | - Chung S. Lim
- Imperial Vascular Unit, Imperial College London, United Kingdom
| | - Manjit S. Gohel
- Imperial Vascular Unit, Imperial College London, United Kingdom
| | - Alun H. Davies
- Imperial Vascular Unit, Imperial College London, United Kingdom
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