CHU de Caen, Service de Neurochirurgie, Caen, France; Université de Caen Basse-Normandie, UFR de Médecine, Caen, France.
CHU de Caen, Service de Neurochirurgie, Caen, France.
World Neurosurg. 2014 Feb;81(2):218-22. doi: 10.1016/j.wneu.2013.01.029. Epub 2013 Jan 10.
Since the mid-1950s, neurosurgery has benefited from the remarkable progress due to tremendous advances in neuroimaging techniques, neuroanesthesia, neurostimulation, and brain-computer interfaces, as well as breakthroughs in operating microscopes and surgical instruments. Yet, this specialty has to do with delicate human structures and is hence considered as highly risky by insurance companies. In France, although neurosurgery's casualty rate (6%) is lower than in other specialties, the number of legal prosecutions has increased since 2002 because of easier access to medicolegal procedures. In order to avoid patients' resorting to the law courts, it becomes necessary to clearly identify the risk factors.
From the data bank of the insurer Société Hospitalière d'Assurances Mutuelles (SHAM, main insurance company for public hospitals in France), we retrospectively analyzed 115 files (34 cranial and 81 spinal surgeries) covering the period 1997-2007 for the reasons for complaints against French neurosurgeons working in public hospitals.
Five main causes were identified: surgical site infection (37%), technical error (22%), lack of information (14%), delayed diagnosis (11%), and lack of supervision (9%).
Some causes are definitely avoidable at no cost to the hospital. Besides basic preventive safety procedures, we reiterate the mandatory steps for a good defense when being prosecuted. The evolution of patients' attitudes toward medical institutions observed in most countries has forced surgeons to adapt their practice. In this context, a common action certified by learned societies on sustainable health care quality, patient safety, and respect of good practices appears as the golden path to maintain a favorable legal, insurance, and financial environment.
自 20 世纪 50 年代中期以来，神经外科受益于神经影像学技术、神经麻醉、神经刺激和脑机接口的巨大进步，以及手术显微镜和手术器械的突破，取得了显著的发展。然而，这个专业涉及到精细的人体结构，因此被保险公司认为风险很高。在法国，尽管神经外科的死亡率（6%）低于其他专业，但自 2002 年以来，由于更容易获得法医程序，法律诉讼的数量有所增加。为了避免患者诉诸法庭，有必要明确确定风险因素。
我们从保险公司 Société Hospitalière d'Assurances Mutuelles（SHAM）的数据库中回顾性分析了 115 份文件（34 份颅脑手术和 81 份脊柱手术），涵盖了 1997 年至 2007 年期间针对在公立医院工作的法国神经外科医生的投诉原因。
确定了五个主要原因：手术部位感染（37%）、技术错误（22%）、信息缺乏（14%）、诊断延误（11%）和监督缺乏（9%）。
有些原因是医院完全可以避免的。除了基本的预防安全措施外，我们还重申了在被起诉时进行良好辩护的强制性步骤。在大多数国家观察到的患者对医疗机构态度的演变迫使外科医生调整他们的做法。在这种情况下，由学会认证的关于可持续医疗保健质量、患者安全和尊重良好实践的共同行动，似乎是维持有利的法律、保险和财务环境的黄金途径。
