Analysis of Insurance Claims after Vascular Surgery: A Tool for Quality Improvement?

Abstract

In this issue of the Journal, Rudstrom et al. analysed the insurance claims after vascular surgery, reported during a 6-year period (2002e2007) to the Swedish Medical Injury Insurance (SMII), and cross-referenced them against the Swedish National Vascular Registry (Swedvasc). Among a total of 193 claims (mostly after elective procedures), 66 were related to varicose veins, 45 to lower extremity, 31 to carotid artery, and 19 to vascular access surgery. The most common causes of claims were peripheral nerve injury (39%), wound infection (14%), and cranial nerve injury (8%). More than half of the patients suffered permanent injuries. As compared to 45% of all claims in SMII, 28% of claims after vascular surgery received economic compensation. Finally, only 18% of core procedures or adverse events were not registered in the Swedvasc, confirming the quality of this national registry. Interestingly, there was no difference in the frequency of insurance claims depending on hospital size, a finding consistent with a previous study from Sweden, in which no difference in the frequency of iatrogenic injuries between hospitals of different size was found. The median 9-month interval between claim and notification is also an important piece of information. Indeed, prolonged settlement procedures should be avoided in order to avoid negative psychological implications on patients and medical staff and also relieve subsequent heavier financial burden imposed on patients and health care providers. A significant strength of this report is certainly the nature of the Swedvasc, which is nationwide since 1994,