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Hoseth JM, Aae TF, Jakobsen RB, Fenstad AM, Bukholm IRK, Gjertsen JE, Randsborg PH. Compensation Claims After Hip Fracture Surgery in Norway 2008-2018. Geriatr Orthop Surg Rehabil 2023; 14:21514593231188623. [PMID: 37435443 PMCID: PMC10331336 DOI: 10.1177/21514593231188623] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 06/23/2023] [Accepted: 06/30/2023] [Indexed: 07/13/2023] Open
Abstract
Background Surgical complications contribute to the significant mortality following hip fractures in the elderly. The purpose of this study was to increase our knowledge of surgical complications by evaluating compensation claims following hip fracture surgery in Norway. Further, we investigated whether the size and location of performing institutions would influence surgical complications. Methods We collected data from the Norwegian System of Patient Injury Compensation (NPE) and the Norwegian Hip Fracture Register (NHFR) from 2008 to 2018. We classified institutions into 4 categories based on annual procedure volume and geographical location. Results 90,601 hip fractures were registered in NHFR. NPE received 616 (.7%) claims. Of these, 221 (36%) were accepted, which accounts for .2% of all hip fractures. Men had nearly a doubled risk of ending with a compensation claim compared to women (OR: 1.8, CI, 1.4-2.4, P < .001). Hospital-acquired infection was the most frequent reason for accepted claims (27%). However, claims were rejected if patients had underlying conditions predisposing to infection. Institutions treating fewer than 152 hip fractures (first quartile) annually, had a statistically significant increased risk (OR: 1.9, CI, 1.3-2.8, P = .005) for accepted claims compared to higher volume facilities. Discussion The fewer registered claims in our study could be due to the relatively high early mortality and frailty in this patient group, which may decrease the likelihood of filing a complaint. Men could have undetected underlying predisposing conditions that lead to increased risk of complications. Hospital-acquired infection may be the most significant complication following hip fracture surgery in Norway. Lastly, the number of procedures performed annually in an institution influences compensation claims. Conclusions Our findings indicate that hospital acquired infections need greater focus following hip fracture surgery, especially in men. Lower volume hospitals may be a risk factor.
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Affiliation(s)
- John Magne Hoseth
- Department of Orthopaedic Surgery, Kristiansund Hospital, Health Møre and Romsdal HF, Kristiansund, Norway
- Faculty of Medicine and Health Sciences, NTNU, Trondheim, Norway
| | - Tommy Frøseth Aae
- Department of Orthopaedic Surgery, Kristiansund Hospital, Health Møre and Romsdal HF, Kristiansund, Norway
- Faculty of Medicine and Health Sciences, NTNU, Trondheim, Norway
| | - Rune Bruhn Jakobsen
- Department of Orthopaedic Surgery, Akershus University Hospital, Lørenskog, Norway
- Institute of Health and Society, The Medical Faculty, University of Oslo Department of Health Management and Health Economics, Oslo, Norway
| | - Anne Marie Fenstad
- The Norwegian Hip Fracture Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway
| | | | - Jan-Erik Gjertsen
- The Norwegian Hip Fracture Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Per-Henrik Randsborg
- Department of Orthopaedic Surgery, Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
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Eggenschwiler LC, Rutjes AWS, Musy SN, Ausserhofer D, Nielen NM, Schwendimann R, Unbeck M, Simon M. Variation in detected adverse events using trigger tools: A systematic review and meta-analysis. PLoS One 2022; 17:e0273800. [PMID: 36048863 PMCID: PMC9436152 DOI: 10.1371/journal.pone.0273800] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 08/15/2022] [Indexed: 11/19/2022] Open
Abstract
Background Adverse event (AE) detection is a major patient safety priority. However, despite extensive research on AEs, reported incidence rates vary widely. Objective This study aimed: (1) to synthesize available evidence on AE incidence in acute care inpatient settings using Trigger Tool methodology; and (2) to explore whether study characteristics and study quality explain variations in reported AE incidence. Design Systematic review and meta-analysis. Methods To identify relevant studies, we queried PubMed, EMBASE, CINAHL, Cochrane Library and three journals in the patient safety field (last update search 25.05.2022). Eligible publications fulfilled the following criteria: adult inpatient samples; acute care hospital settings; Trigger Tool methodology; focus on specialty of internal medicine, surgery or oncology; published in English, French, German, Italian or Spanish. Systematic reviews and studies addressing adverse drug events or exclusively deceased patients were excluded. Risk of bias was assessed using an adapted version of the Quality Assessment Tool for Diagnostic Accuracy Studies 2. Our main outcome of interest was AEs per 100 admissions. We assessed nine study characteristics plus study quality as potential sources of variation using random regression models. We received no funding and did not register this review. Results Screening 6,685 publications yielded 54 eligible studies covering 194,470 admissions. The cumulative AE incidence was 30.0 per 100 admissions (95% CI 23.9–37.5; I2 = 99.7%) and between study heterogeneity was high with a prediction interval of 5.4–164.7. Overall studies’ risk of bias and applicability-related concerns were rated as low. Eight out of nine methodological study characteristics did explain some variation of reported AE rates, such as patient age and type of hospital. Also, study quality did explain variation. Conclusion Estimates of AE studies using trigger tool methodology vary while explaining variation is seriously hampered by the low standards of reporting such as the timeframe of AE detection. Specific reporting guidelines for studies using retrospective medical record review methodology are necessary to strengthen the current evidence base and to help explain between study variation.
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Affiliation(s)
- Luisa C. Eggenschwiler
- Institute of Nursing Science (INS), Department Public Health (DPH), Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Anne W. S. Rutjes
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Sarah N. Musy
- Institute of Nursing Science (INS), Department Public Health (DPH), Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Dietmar Ausserhofer
- Institute of Nursing Science (INS), Department Public Health (DPH), Faculty of Medicine, University of Basel, Basel, Switzerland
- College of Health Care-Professions Claudiana, Bozen-Bolzano, Italy
| | - Natascha M. Nielen
- Institute of Nursing Science (INS), Department Public Health (DPH), Faculty of Medicine, University of Basel, Basel, Switzerland
| | - René Schwendimann
- Institute of Nursing Science (INS), Department Public Health (DPH), Faculty of Medicine, University of Basel, Basel, Switzerland
- Patient Safety Office, University Hospital Basel, Basel, Switzerland
| | - Maria Unbeck
- School of Health and Welfare, Dalarna University, Falun, Sweden
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Michael Simon
- Institute of Nursing Science (INS), Department Public Health (DPH), Faculty of Medicine, University of Basel, Basel, Switzerland
- * E-mail:
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Aae TF, Jakobsen RB, Bukholm IRK, Fenstad AM, Furnes O, Randsborg PH. Compensation claims after hip arthroplasty surgery in Norway 2008-2018. Acta Orthop 2021; 92:311-315. [PMID: 33459568 PMCID: PMC8231378 DOI: 10.1080/17453674.2021.1872901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Orthopedic surgery is one of the specialties with most compensation claims, therefore we assessed the most common reasons for complaints following total hip arthroplasty (THA) reported to the Norwegian System of Patient Injury Compensation (NPE) and viewed these complaints in light of the data from the Norwegian Arthroplasty Register (NAR).Patients and methods - We collected data from NPE and NAR for the study period (2008-2018), including age, sex, and type of complaint, and reason for accepted claims from NPE, and the number of arthroplasty surgeries from NAR. The institutions were grouped by quartiles into quarters according to annual procedure volume, and the effect of hospital procedure volume on the risk for accepted claim was estimated.Results - 70,327 THAs were reported to NAR. NPE handled 1,350 claims, corresponding to 1.9% of all reported THAs. 595 (44%) claims were accepted, representing 0.8% of all THAs. Hospital-acquired infection was the most common reason for accepted claims (34%), followed by wrong implant position in 11% of patients. Low annual volume institutions (less than 93 THAs per year) had a statistically significant 1.6 times higher proportion of accepted claims compared with higher volume institutions.Interpretation - The 0.8% risk of accepted claims following THAs is 1.6 times higher for patients treated in low-volume institutions, which should consider increasing the volume of THAs or referring these patients to higher volume institutions.
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Affiliation(s)
- Tommy Frøseth Aae
- Department of Orthopaedic Surgery, Health Møre and Romsdal HF, Kristiansund Hospital, Kristiansund
| | - Rune Bruhn Jakobsen
- Department of Orthopaedic Surgery, Akershus University Hospital, Lørenskog
- Department of Health Management and Health Economics, Institute of Health and Society, The Medical Faculty, University of Oslo
| | | | - Anne Marie Fenstad
- The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen
| | - Ove Furnes
- The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen
- Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Per-Henrik Randsborg
- Department of Orthopaedic Surgery, Akershus University Hospital, Lørenskog
- Sports Medicine Institute, Hospital for Special Surgery, New York, USA
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Magnéli M, Unbeck M, Rogmark C, Sköldenberg O, Gordon M. Measuring adverse events following hip arthroplasty surgery using administrative data without relying on ICD-codes. PLoS One 2020; 15:e0242008. [PMID: 33152055 DOI: 10.1371/journal.pone.0242008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 10/26/2020] [Indexed: 01/29/2023] Open
Abstract
Introduction Measure and monitor adverse events (AEs) following hip arthroplasty is challenging. The aim of this study was to create a model for measuring AEs after hip arthroplasty using administrative data, such as length of stay and readmissions, with equal or better precision than an ICD-code based model. Materials and methods This study included 1 998 patients operated with an acute or elective hip arthroplasty in a national multi-centre study. We collected AEs within 90 days following surgery with retrospective record review. Additional data came from the Swedish Hip Arthroplasty Register, the Swedish National Patient Register and the Swedish National Board of Health and Welfare. We made a 2:1 split of the data into a training and a holdout set. We used the training set to train different machine learning models to predict if a patient had sustained an AE or not. After training and cross-validation we tested the best performing model on the holdout-set. We compared the results with an established ICD-code based measure for AEs. Results The best performing model was a logistic regression model with four natural age splines. The variables included in the model were as follows: length of stay at the orthopaedic department, discharge to acute care, age, number of readmissions and ED visits. The sensitivity and specificity for the new model was 23 and 90% for AE within 30 days, compared with 5 and 94% for the ICD-code based model. For AEs within 90 days the sensitivity and specificity were 31% and 89% compared with 16% and 92% for the ICD-code based model. Conclusion We conclude that a prediction model for AEs following hip arthroplasty surgery, relying on administrative data without ICD-codes is more accurate than a model based on ICD-codes.
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Khan N, Petersen MM, Mikkelsen KL, Schrøder HM. No-Fault Compensation From the Patient Compensation Association in Denmark After Primary Total Hip Replacement in Danish Hospitals 2005-2017. J Arthroplasty 2020; 35:1784-1791. [PMID: 32220482 DOI: 10.1016/j.arth.2020.02.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 02/13/2020] [Accepted: 02/19/2020] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND There is an annually rising number of performed total hip arthroplasty (THA) surgeries in Denmark and this is expected to become even more common. However, there are still risks of adverse events, which become the basis for compensation claims. In Denmark, there are no studies available concerning filed claims after THA. The aims of this study are to determine the incidence of claims related to THAs in Denmark, the reasons to claim, which claims lead to compensation, the amount of compensation, and trends over time. METHODS In this observational study, we analyzed all closed claims between 2005 and 2017 from the Danish Patient Compensation Association (DPCA). With the intention to contribute to prevention, we have identified the number and outcome of claims. RESULTS There were 2924 cases (ie, 2.5% of all THAs performed in this period). The approval rate was 54%. The number of claims filed was stagnant over time, except for a spike of metal-on-metal (MoM) prosthesis cases. The total payout was USD 29,591,045, and 87% of this was due to nerve damage (USD 9,106,118), infection (USD 6,046,948), MoM prosthesis (USD 4,624,353), insufficient or incorrect treatment (USD 472,500), and fracture (USD 2,088,110). CONCLUSION In total, 2.5% of all THAs performed between 2005 and 2017 lead to a claim submission at the DPCA. One of 2 claims were approved. The majority of payouts were due to nerve damage, infection, MoM prosthesis, insufficient or incorrect treatment, and fracture. Although DPCA manages claims for patients, the data can also provide beneficial feedback to arthroplasty surgeons with the aim of improving patient care.
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Affiliation(s)
- Nissa Khan
- Department of Orthopedic Surgery, Holbæk Hospital, Holbæk, Denmark
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