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Lian OM, Randsborg PH, Jakobsen RB, Khan Bukholm IR, Aae TF. Prevalence of malpractice claims after arthroscopic shoulder surgery: analysis of 69,097 procedures from a national registry in Norway. Patient Saf Surg 2023; 17:25. [PMID: 37853493 PMCID: PMC10585783 DOI: 10.1186/s13037-023-00378-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 10/06/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND Systematic analysis of compensation claims following patient injuries is helpful in improving patient safety. The objective of the current study was to assess compensation claims after arthroscopic treatment of rotator cuff ruptures, impingement, and acromioclavicular joint osteoarthritis reported to the Norwegian System of Patient Injury Compensation and evaluate if there was regional variation on the risk of patient injuries leading to an accepted compensation claim. METHODS Data from the Norwegian System of Patient Injury Compensation and the Norwegian Patient Registry (NPR) from 2008 to 2018 were collected. Demographics (age and sex) and type of claim and reasons for accepted claims were obtained from the Norwegian System of Patient Injury Compensation, while the number of arthroscopic procedures was collected from NPR. The treating institutions were grouped on geography according to Norway's four regional Health Trusts and private institutions and the effect of geography on the probability of an accepted claim was estimated. RESULTS NPR registered 69,097 shoulder arthroscopies during the study period, of which 216 (0.3%) compensation claims were filed for patient injury. A total of 38% of the claims were accepted, representing 0.1% of the arthroscopic procedures. Infection (37.8%) was the most common reason for accepted claim, followed by no surgical indication (15.9%) and wrong surgical technique (12.2%). We found a statistically significantly increased odds ratio for a claim being accepted in both the smallest and largest regional Health Trusts compared to the other regional Health Trusts and private institutions. CONCLUSIONS Compensation claims due to patient injury following shoulder arthroscopy are rare (0.3% of patients file a claim, of which a third is accepted (0.1% of all shoulder arthroscopy patients)). The most common reason for accepted claim was infection followed by lack of indication.
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Affiliation(s)
- Ola Midtsaether Lian
- Department of Orthopaedic Surgery, Helse Møre and Romsdal HT, Kristiansund Hospital, Kristiansund, Norway
- Faculty of Medicine and Health Sciences, NTNU, Trondheim, 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
| | - Rune Bruhn Jakobsen
- Department of Orthopaedic Surgery, Akershus University Hospital, Lørenskog, Norway
- Department of Health Management and Health Economics, Institute of Health and Society, The Medical Faculty, University of Oslo, Oslo, Norway
| | | | - Tommy Frøseth Aae
- Department of Orthopaedic Surgery, Helse Møre and Romsdal HT, Kristiansund Hospital, Kristiansund, Norway
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, NTNU, Trondheim, Norway
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Nyrhinen KM, Helkamaa T, Bister V, Schlenzka A, Sandelin H, Sandelin J, Harilainen A. Patient injury claims for posterior cruciate ligament injury: a nationwide registry study in Finland. Acta Orthop 2023; 94:426-431. [PMID: 37592854 PMCID: PMC10436284 DOI: 10.2340/17453674.2023.18265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 07/06/2023] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND AND PURPOSE Posterior cruciate ligament (PCL) injuries usually occur in combination with other ligamentous knee injuries. The outcome varies and may be poor due to suboptimal treatment. We investigated claims following PCL injury treatment on a nationwide scale. PATIENTS AND METHODS All patient PCL injury claims filed in Finland from 1997 to 2015 were collected from the Patient Insurance Centre (PIC) register. We reviewed and analyzed all records to determine the causes of claims. General background data were obtained from the National Care Register for Social Welfare and Health Care (HILMO). RESULTS We found out from HILMO background data that, during the 19-year study period, 1,891 PCL and 1,380 multiligament reconstructions were performed in 99 different hospitals. The number of PCL injuries treated conservatively is unknown. During this same period, 49 claims arrived at the PIC, and 39/49 of these patients were operated on. 12/49 claims were compensated. Of these 12 claims, 6 were compensated for technical errors and 4 were compensated for diagnostic delays. CONCLUSION The number of patient injury claims was few, and compensated claims were even fewer. Technical errors and diagnostic delays were the most common reasons for reimbursement.
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Affiliation(s)
- Kirsi-Maaria Nyrhinen
- Department of Orthopaedics and Traumatology, University of Helsinki and Helsinki University Hospital, Helsinki.
| | - Teemu Helkamaa
- Department of Orthopaedics and Traumatology, University of Helsinki and Helsinki University Hospital, Helsinki
| | - Ville Bister
- Department of Orthopaedics and Traumatology, University of Helsinki and Helsinki University Hospital, Helsinki; Department of Surgery, Faculty of Medicine, University of Helsinki, Helsinki
| | - Arne Schlenzka
- Department of Orthopaedics and Traumatology, University of Helsinki and Helsinki University Hospital, Helsinki
| | - Henrik Sandelin
- Department of Orthopaedics and Traumatology, Vaasa Central Hospital, Vaasa, and University of Helsinki, Helsinki; Mehiläinen Sports Hospital, Vaasa; 5 Orton Orthopaedic Hospital, Helsinki, Finland
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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] [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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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] [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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Randsborg PH, Aae TF, Bukholm IRK, Fenstad AM, Furnes O, Jakobsen RB. Compensation claims after knee arthroplasty surgery in Norway 2008-2018. Acta Orthop 2021; 92:189-193. [PMID: 33439091 PMCID: PMC8158226 DOI: 10.1080/17453674.2020.1871187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [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. We assessed the claims following knee arthroplasty surgery reported to the Norwegian System of Patient Injury Compensation (NPE) in light of institutional procedure volume.Patients and methods - We collected data from NPE and the Norwegian Arthroplasty Register (NAR) for the study period (2008-2018). Age, sex, type of claim, and reason for compensation were collected from NPE, while the number of arthroplasty surgeries was collected from NAR. The treating hospitals were grouped by quartiles according to annual procedure volume. The effect of hospital volume on the likelihood of an accepted claim was estimated.Results - NAR received 64,241 reports of arthroplasty procedures, of which 572 (0.9%) patients filed a claim for treatment injury. 55% of the claims were accepted, representing 0.5% of all knee arthroplasties. The most common reason for accepted claim was a hospital-acquired infection, in 28% of the patients, followed by misplaced implant (26%) and aseptic loosening (13%). The hospitals with the lowest annual volume (57 or fewer arthroplasties per year, first quarter) had a statistically significantly larger fraction of granted claims per procedures compared with other institutions.Interpretation - The overall risk of ending up with compensation due to treatment error following knee arthroplasty was 0.5%. The risk of accepted claim was greater for patients operated in the lowest volume hospitals.
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Affiliation(s)
- Per-Henrik Randsborg
- Department of Orthopaedic Surgery, Akershus University Hospital, Lørenskog, Norway; ,Sports Medicine Institute, Hospital for Special Surgery, New York, USA; ,Correspondence:
| | - Tommy Frøseth Aae
- Department of Orthopedic Surgery, Health Møre and Romsdal HF, Kristiansund Hospital, Kristiansund, Norway;
| | | | - Anne Marie Fenstad
- Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway;
| | - Ove Furnes
- Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway; ,Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Rune Bruhn Jakobsen
- Department of Orthopaedic Surgery, Akershus University Hospital, Lørenskog, Norway; ,Department of Health Management and Health Economics, Medical Faculty, University of Oslo, Oslo, Norway;
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