Compensation claims after knee cartilage surgery is rare. A registry-based study from Scandinavia from 2010 to 2015

Bukholm³

et al. 2021

Acta Orthopaedica

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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.

Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Compensation claims after hip arthroplasty surgery in Norway 2008–2018

Bukholm³

et al. 2021

Acta Orthopaedica

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“…The main reason for compensation was hospital-acquired infection. This is also the most common reason for accepted claims after other elective knee procedures, such as anterior cruciate ligament reconstruction and cartilage surgery (Randsborg et al 2018, Aae et al 2020. The proportion of accepted claims due to infection was particularly high for UKA compared with TKA (p = 0.06).…”

Section: Discussionmentioning

confidence: 99%

“…Nevertheless, our findings serve as a reminder that nonoperative measures and correlation between radiological findings and clinical symptoms remain cornerstones in the indication for knee arthroplasty (Schmitt et al 2017). Unfortunately, avoidable treatment injuries such as wrong indication or inadequate follow-up remain major reasons for accepted claims in orthopedic surgery (Randsborg et al 2018, Aae et al 2020. These are modifiable factors and demonstrate how compensation claim reports can be useful for clinicians to learn from other people's mistakes.…”

Section: Discussionmentioning

confidence: 99%

Compensation claims after knee arthroplasty surgery in Norway 2008–2018

Bukholm³

et al. 2021

Acta Orthopaedica

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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.

“…Whereas in the UK and the US it is the judicial system that manages the injury compensation through tort liability. 10 Deilkås et al found a significantly higher rate of surgical adverse events in Norwegian hospitals (1.4%) compared to Swedish hospitals (.6%), which can be explained by a more centralized care in Sweden compared to Norway. 11 The relatively high early mortality and frailty (including cognitive impairment) in this patient group may decrease the likelihood of filing a complaint.…”

Section: Discussionmentioning

confidence: 96%

Compensation Claims After Hip Fracture Surgery in Norway 2008-2018

Hoseth

Geriatr Orthop Surg Rehabil

et al. 2023

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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.