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Vicente-Guijarro J, Valencia-Martín JL, Fernández-Herreruela C, Sousa P, Mira Solves JJ, Aranaz-Andrés JM. Surgical Error Compensation Claims as a Patient Safety Indicator: Causes and Economic Consequences in the Murcia Health System, 2002 to 2018. J Patient Saf 2022; 18:276-286. [PMID: 35503970 PMCID: PMC9162075 DOI: 10.1097/pts.0000000000000917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Compensation claims are a useful source of information on patient safety research. The purpose of this study was to determine the main causes of surgical compensation claims and their financial impact on the health system. METHODS A descriptive observational study with analytical components was carried out on compensation claims brought against the surgical area of the Murcia Health System between 2002 and 2018. We analyzed the frequency, causes, consequences, locations and surgical settings of these claims, the time of judicial procedure, and compensation adjusted to the Consumer Price Index. RESULTS There were 1172 compensation claims. "orthopedic surgery and traumatology" (27.4%), "gynecology and obstetrics" (25.7%), and "general surgery" (17.2%) were the main surgical settings involved. The most frequent causes were surgical error (42.4%) and treatment error (30.9%). The main sequelae were musculoskeletal (20.0%), neurological (17.7%), and obstetric (17.7%). The average time from incident to resolution of claims was 6.3 years. A total of 20.1% of these claims were successful, particularly those involving retained surgical foreign bodies (71.4% successful claims; P < 0.001). The total compensation paid was €56,338,247 (an average of €17,207 per claim). Compensation was higher in cases with respiratory sequelae (median, 131,600; P = 0.033), death (75,916; P < 0.001), and neurological (60,000; P = 0.024). CONCLUSIONS Compensation claims associated with surgical procedures are made on a variety of grounds. They are drawn-out proceedings, and patients are only successful in 20% of cases.
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Affiliation(s)
- Jorge Vicente-Guijarro
- From the Servicio de Medicina Preventiva y Salud Pública, Hospital Universitario Ramón y Cajal, IRYCIS
- Departamento de Medicina y Especialidades Médicas, Facultad de Medicina, Universidad de Alcalá, Acalá de Henares
- Instituto Ramón y Cajal de Investigación Sanitaria, IRYCIS, Madrid
| | - José Lorenzo Valencia-Martín
- Instituto Ramón y Cajal de Investigación Sanitaria, IRYCIS, Madrid
- Servicio de Medicina Preventiva y Salud Pública, Hospital Universitario Virgen del Rocío, Sevilla
| | - Carlos Fernández-Herreruela
- Dirección Asistencial Noroeste, Gerencia Asistencial de Atención Primaria, Servicio Madrileño de Salud
- Perito Médico de Seguros, Asesor en Gestión de Riesgos Sanitarios, Madrid, Spain
| | - Paulo Sousa
- NOVA National School of Public Health, Universidade NOVA de Lisboa
- Comprehensive Health Research Centre (CHRC), Lisbon, Portugal
| | - José Joaquín Mira Solves
- Health Psychology Department, Miguel Hernández University, Elche
- Alicante-Sant Joan Health District, Consellería Sanitat, Alicante
- REDISSEC, Health Services Network Oriented to Chronic Diseases
| | - Jesús María Aranaz-Andrés
- From the Servicio de Medicina Preventiva y Salud Pública, Hospital Universitario Ramón y Cajal, IRYCIS
- Instituto Ramón y Cajal de Investigación Sanitaria, IRYCIS, Madrid
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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Tivey DR, Davis SS, Kovoor JG, Babidge WJ, Tan L, Hugh TJ, Collinson TG, Hewett PJ, Padbury RTA, Maddern GJ. Safe surgery during the coronavirus disease 2019 crisis. ANZ J Surg 2020; 90:1553-1557. [PMID: 32594617 PMCID: PMC7361254 DOI: 10.1111/ans.16089] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 06/03/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has created a global pandemic. Surgical care has been impacted, with concerns raised around surgical safety, especially in terms of laparoscopic versus open surgery. Due to potential aerosol transmission of SARS-CoV-2, precautions during aerosol-generating procedures and production of surgical plume are paramount for the safety of surgical teams. METHODS A rapid review methodology was used with evidence sourced from PubMed, Departments of Health, surgical colleges and other health authorities. From this, a working group of expert surgeons developed recommendations for surgical safety in the current environment. RESULTS Pre-operative testing of surgical patients with reverse transcription-polymerase chain reaction does not guarantee lack of infectivity due to a demonstrated false-negative rate of up to 30%. All bodily tissues and fluids should therefore be treated as a potential source of COVID-19 infection during operative management. Caution must be taken, especially when using an energy source that produces surgical plumes, and an appropriate capture device should also be used. Limiting the use of such devices or using lower energy devices is desirable. To reduce perceived risks association with desufflation of pneumoperitoneum during laparoscopic surgery, an appropriate suction irrigator system, attached to a high-efficiency particulate air filter, should be used. Additionally, appropriate use of personal protective equipment by the surgical team is necessary during high-risk aerosol-generating procedures. CONCLUSIONS As a result of the rapid review, evidence-based guidance has been produced to support safe surgical practice.
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Affiliation(s)
- David R Tivey
- Research Audit and Academic Surgery, Royal Australasian College of Surgeons, Adelaide, South Australia, Australia.,University of Adelaide, Discipline of Surgery, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
| | - Sean S Davis
- University of Adelaide, Discipline of Surgery, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
| | - Joshua G Kovoor
- University of Adelaide, Adelaide, South Australia, Australia
| | - Wendy J Babidge
- Research Audit and Academic Surgery, Royal Australasian College of Surgeons, Adelaide, South Australia, Australia.,University of Adelaide, Discipline of Surgery, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
| | - Lorwai Tan
- Research Audit and Academic Surgery, Royal Australasian College of Surgeons, Adelaide, South Australia, Australia
| | - Thomas J Hugh
- Northern Clinical School, University of Sydney, Sydney, New South Wales, Australia.,Surgical Education, Research and Training Institute, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | | | - Peter J Hewett
- University of Adelaide, Discipline of Surgery, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
| | - Robert T A Padbury
- Flinders University, Adelaide, South Australia, Australia.,Division of Surgery and Perioperative Medicine, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Guy J Maddern
- Research Audit and Academic Surgery, Royal Australasian College of Surgeons, Adelaide, South Australia, Australia.,University of Adelaide, Discipline of Surgery, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
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Torborg A, Cronje L, Thomas J, Meyer H, Bhettay A, Diedericks J, Cilliers C, Kluyts H, Mrara B, Kalipa M, Rodseth R, Biccard B. South African Paediatric Surgical Outcomes Study: a 14-day prospective, observational cohort study of paediatric surgical patients. Br J Anaesth 2018; 122:224-232. [PMID: 30686308 DOI: 10.1016/j.bja.2018.11.015] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 10/29/2018] [Accepted: 11/17/2018] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND Children comprise a large proportion of the population in sub-Saharan Africa. The burden of paediatric surgical disease exceeds available resources in Africa, potentially increasing morbidity and mortality. There are few prospective paediatric perioperative outcomes studies, especially in low- and middle-income countries (LMICs). METHODS We conducted a 14-day multicentre, prospective, observational cohort study of paediatric patients (aged <16 yrs) undergoing surgery in 43 government-funded hospitals in South Africa. The primary outcome was the incidence of in-hospital postoperative complications. RESULTS We recruited 2024 patients at 43 hospitals. The overall incidence of postoperative complications was 9.7% [95% confidence interval (CI): 8.4-11.0]. The most common postoperative complications were infective (7.3%; 95% CI: 6.2-8.4%). In-hospital mortality rate was 1.1% (95% CI: 0.6-1.5), of which nine of the deaths (41%) were in ASA physical status 1 and 2 patients. The preoperative risk factors independently associated with postoperative complications were ASA physcial status, urgency of surgery, severity of surgery, and an infective indication for surgery. CONCLUSIONS The risk factors, frequency, and type of complications after paediatric surgery differ between LMICs and high-income countries. The in-hospital mortality is 10 times greater than in high-income countries. These findings should be used to develop strategies to improve paediatric surgical outcomes in LMICs, and support the need for larger prospective, observational paediatric surgical outcomes research in LMICs. CLINICAL TRIAL REGISTRATION NCT03367832.
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Affiliation(s)
- A Torborg
- Discipline of Anaesthesiology and Critical Care, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Congella, Kwazulu-Natal, South Africa.
| | - L Cronje
- Discipline of Anaesthesiology and Critical Care, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Congella, Kwazulu-Natal, South Africa
| | - J Thomas
- Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital, South Africa; Division of Paediatric Anaesthesia, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, Western Cape, South Africa
| | - H Meyer
- Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital, South Africa; Division of Paediatric Anaesthesia, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, Western Cape, South Africa
| | - A Bhettay
- Department of Anaesthesia and Pain Medicine, Nelson Mandela Children's Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - J Diedericks
- Department of Anaesthesiology, University of the Free State, Bloemfontein, South Africa
| | - C Cilliers
- Department of Anaesthesiology and Critical Care, Stellenbosch University, Cape Town, South Africa
| | - H Kluyts
- Department of Anaesthesiology, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - B Mrara
- Department of Anaesthesia, Walter Sisulu University, Eastern Cape, South Africa
| | - M Kalipa
- Department of Anaesthesiology, University of Pretoria, Gauteng, South Africa
| | - R Rodseth
- Discipline of Anaesthesiology and Critical Care, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Congella, Kwazulu-Natal, South Africa
| | - B Biccard
- Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital, South Africa
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Abstract
BACKGROUND A consumer model of health supports that people undergoing elective surgery should be informed about the past operative performance of their surgeon before making two important decisions: 1. to consent to the proposed surgery, and 2. to have a particular doctor perform the surgery. This information arguably helps empower patients to participate in their care. While surgeons' performance data are available in some settings, there continues to be controversy over the provision of such data to patients, and the question of whether consumers should, or want to, be provided with this information. OBJECTIVES To assess the effects of providing a surgeon's performance data to people considering elective surgery on patient-based and service utilisation outcomes. SEARCH METHODS For the original review, we searched: the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, 2009, Issue 4); MEDLINE (Ovid) (1950 to 28 September 2009); EMBASE (Ovid) (1988 to 28 September 2009); PsycINFO (Ovid) (1806 to 28 September 2009); CINAHL (EBSCO) (1982 to 20 October 2009); Current Contents (Ovid) (1992 to 23 November 2009); and ProQuest Dissertations and Theses (1861 to 20 October 2009).For this update, we searched: CENTRAL (2009 to 3 March 2014); MEDLINE (Ovid) (2009 to 3 March 2014); EMBASE (Ovid) (2009 to 3 March 2014); PsycINFO (Ovid) (2009 to 9 March 2014); CINAHL (EBSCO) (2009 to 9 March 2014), Current Contents (Web of Science) (November 2009 to 21 March 2014), and ProQuest Dissertations and Theses (2009 to 21 March 2014). We applied no language restrictions. SELECTION CRITERIA Randomised controlled trials (RCTs), cluster RCTs, quasi-RCTs and controlled before and after studies (CBAs), in which an individual surgeon's performance data were provided to people considering elective surgery. We considered the CBAs for inclusion from 2009 onwards. DATA COLLECTION AND ANALYSIS Two review authors (AH, SH) independently assessed all titles, abstracts, or both of retrieved citations. We identified no studies for inclusion. Consequently, we conducted no data collection or analysis. MAIN RESULTS We found no studies that met the inclusion criteria; therefore, there are no results to report on the effect of the provision of a surgeon's performance data for people considering elective surgery. AUTHORS' CONCLUSIONS We found no studies reporting the impact of the provision of a surgeon's performance data for people considering elective surgery. This is an important finding in itself. While the public reporting of a surgeon's performance is not a new concept, the efficacy of this data for individual patients has not been empirically tested. A review of qualitative studies or new primary qualitative research may be useful to determine what interventions are currently in use and explore the attitudes of consumers and professionals towards such interventions.
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Affiliation(s)
- Amanda Henderson
- School of Nursing and Midwifery, Sunshine Coast University, Sippy Downs, Queensland, Australia, 4556. .
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Merrill WH. Preparing the next generation of residents to care for patients with cardiothoracic disease. Tex Heart Inst J 2012; 39:878-879. [PMID: 23304044 PMCID: PMC3528240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- Walter H Merrill
- Department of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, Tennessee 37232-2102, USA.
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