What can we learn from patient claims? - A retrospective analysis of incidence and patterns of adverse events after orthopaedic procedures in Sweden

Annica Öhrn,Hans Tropp,Johan Elfström,Hans Rutberg

doi:10.1186/1754-9493-6-2

Abstract

BackgroundObjective data on the incidence and pattern of adverse events after orthopaedic surgical procedures remain scarce, secondary to the reluctance for encompassing reporting of surgical complications. The aim of this study was to analyze the nature of adverse events after orthopaedic surgery reported to a national database for patient claims in Sweden.MethodsIn this retrospective review data from two Swedish national databases during a 4-year period were analyzed. We used the "County Councils' Mutual Insurance Company", a national no-fault insurance system for patient claims, and the "National Patient Register at the National Board of Health and Welfare".ResultsA total of 6,029 patient claims filed after orthopaedic surgery were assessed during the study period. Of those, 3,336 (55%) were determined to be adverse events, which received financial compensation. Hospital-acquired infections and sepsis were the most common causes of adverse events (n = 741; 22%). The surgical procedure that caused the highest rate of adverse events was "decompression of spinal cord and nerve roots" (code ABC**), with 168 adverse events of 17,507 hospitals discharges (1%). One in five (36 of 168; 21.4%) injured patient was seriously disabled or died.ConclusionsWe conclude that patients undergoing spinal surgery run the highest risk of being severely injured and that these patients also experienced a high degree of serious disability. The most common adverse event was related to hospital acquired infections. Claims data obtained in a no-fault system have a high potential for identifying adverse events and learning from them.

Highlights

Objective data on the incidence and pattern of adverse events after orthopaedic surgical procedures remain scarce, secondary to the reluctance for encompassing reporting of surgical complications
During the study period, 6029 patient claims were filed after orthopaedic care
The most common reason for rejecting a patient claim was that the injury was assessed as an “unavoidable consequence” of the treatment (27%) or “injury not related to treatment” (24%)

Summary

Introduction

Objective data on the incidence and pattern of adverse events after orthopaedic surgical procedures remain scarce, secondary to the reluctance for encompassing reporting of surgical complications. The aim of this study was to analyze the nature of adverse events after orthopaedic surgery reported to a national database for patient claims in Sweden. Adverse events in connection with medical care are common [1,2,3,4] and, based on medical record reviews, several studies have shown that surgical specialities contribute a large share of adverse events [2,3,5]. A Swedish study estimated the number of preventable adverse events as high as 8.6%. Six percent of these adverse events were serious, contributed to death or permanent. A study from the national Norwegian Patient Compensation System showed that 47% of all patient claims were filed after orthopaedic treatment [12]. Orthopaedic surgery is one of the surgical specialities with most claims [13]

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