Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
Department of Obstetrics and Gynecology, St. Olav's Hospital, University Hospital of Trondheim, Trondheim, Norway.
Acta Obstet Gynecol Scand. 2019 Aug;98(8):1070-1076. doi: 10.1111/aogs.13605. Epub 2019 Apr 9.
The Norwegian System of Patient Injury Compensation (NPE) evaluates all patient-reported claims in Norway. Our aim was to study the cases from gynecological patients approved by NPE in order to identify the main reasons for the injuries, the consequences of the treatment failure for the women, and the time course when the treatment failure occurred.
A retrospective, descriptive study of approved gynecological compensation claims during a 14-year period, based on patient files from NPE.
In all, 1454 women claimed compensation for injury related to gynecological treatment in Norway from 2000 to 2013. Compensation was approved for 438 (30.1%) women. Eleven women declined participation in the study and 16 cases were excluded, leaving 411 cases for further analyses. Consent to participate was given by 211 (51.3%) women, who gave full access to all their NPE files. Anonymized resumes and expert statements were used for the 138 (33.6%) women who did not respond and the 62 (15.1%) women who were deceased. Guidelines or good clinical practice were not followed in 40.5% of the cases. The most common reasons for injury were surgical complications (67.6%), delayed (22.4%) and incorrect (17.0%) diagnoses, and failure of communication (11.7%). The main consequences of injuries were need for extensive treatment (64.2%), permanent injury (55.2%) and impaired physical ability (41.9%). Worsening of cancer prognosis occurred in 58 women (14.1%) and death due to treatment failure in 29 (7.1%) women. Most failures occurred during the treatment period (75.2%).
We found that the main reason for injuries in gynecological patients was non-adherence to guidelines or good clinical practice. Surgery-related injuries were most common. Increased focus on adherence to guidelines and surgical skills might improve patient safety for gynecological patients in Norway.
挪威患者伤害赔偿制度（NPE）对挪威所有患者报告的索赔进行评估。我们的目的是研究 NPE 批准的妇科患者案例，以确定伤害的主要原因、治疗失败对女性的后果以及治疗失败发生的时间过程。
这是一项基于 NPE 患者档案的回顾性、描述性研究，对 14 年来批准的妇科赔偿索赔进行了研究。
2000 年至 2013 年期间，挪威共有 1454 名女性因妇科治疗相关伤害要求赔偿，其中 438 名（30.1%）女性获得赔偿。11 名女性拒绝参与研究，16 例被排除在外，其余 411 例用于进一步分析。211 名（51.3%）女性同意参与，她们允许全面查阅所有 NPE 文件。对于未回复的 138 名（33.6%）女性和 62 名（15.1%）已故女性，使用了匿名简历和专家陈述。40.5%的案例未遵循指南或良好临床实践。受伤的最常见原因是手术并发症（67.6%）、延迟（22.4%）和错误（17.0%）诊断以及沟通失败（11.7%）。受伤的主要后果是需要广泛治疗（64.2%）、永久性损伤（55.2%）和身体能力受损（41.9%）。58 名女性（14.1%）的癌症预后恶化，29 名女性（7.1%）因治疗失败死亡。大多数失败发生在治疗期间（75.2%）。
我们发现，妇科患者受伤的主要原因是不遵守指南或良好临床实践。与手术相关的伤害最为常见。增加对遵守指南和手术技能的关注可能会提高挪威妇科患者的安全性。
