From Practice Improvement, Canadian Medical Protective Association, Ottawa, Ont. (Lefebvre, Mimeault); Medical Care Analytics, Canadian Medical Protective Association, Ottawa, Ont. (Devenny, Héroux, Bowman, Neilson, Calder); the Department of Obstetrics and Gynecology, University of Ottawa, Shirley E. Greenberg Women's Health Centre, Ottawa, Ont. (Singh); and the Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ont. (Calder).
Can J Surg. 2021 Mar 5;64(2):E127-E134. doi: 10.1503/cjs.010219.
Intraoperative injuries during abdominopelvic surgery can be associated with substantial patient harm. The objective of this study was to describe abdominopelvic intraoperative injuries and their contributing factors among medicolegal cases.
This study was a descriptive analysis of medicolegal matters reported to a national body, with subgroup analyses by type of surgery. We reviewed medicolegal matters involving a population-based sample of physicians who were subject to a civil legal action or complaint to a regulatory authority that was closed between 2013 and 2017 in Canada.
Our analysis included 181 civil legal cases and 88 complaints to a regulatory authority. Among legal cases, 155 patients (85.6%) (median age 47 yr) underwent elective procedures. The most common injury site was the bowel (53 cases [29.3%]). Injuries frequently occurred during dissection (79 [43.6%]) and ligation (38 [21.0%]), were identified postoperatively (138 [76.2%]) and necessitated further surgery (139 [76.8%]). Many patients experienced severe harm (55 [30.4%]) or died (25 [13.8%]). Peer experts in nongynecologic cases were more likely than those in gynecologic cases to include criticisms of a provider in a harmful incident (79 [71.2%] v. 30 [42.9%], p < 0.01). Peer expert criticisms often related to clinical evaluation, decision-making and misidentification of anatomy. Criticisms of nontechnical skills identified documentation and communication deficiencies.
This study confirms the importance of provider and team training to improve clinical evaluation and decision-making, documentation and communication. Effective protocols may help support clinicians in providing safer surgical care.
腹盆腔手术过程中的损伤可能会给患者带来严重的伤害。本研究旨在描述医疗纠纷案例中腹盆腔手术过程中的损伤及其相关因素。
本研究对向国家机构报告的医疗纠纷案例进行描述性分析，并按手术类型进行亚组分析。我们回顾了 2013 年至 2017 年间加拿大因民事法律诉讼或向监管机构投诉而涉及到的、基于人群的医生样本的医疗纠纷案例。
我们的分析包括 181 例民事法律案例和 88 例向监管机构的投诉。在法律案例中，155 名患者（85.6%）（中位年龄 47 岁）接受了择期手术。最常见的损伤部位是肠道（53 例[29.3%]）。损伤常发生在解剖过程中（79 例[43.6%]）和结扎过程中（38 例[21.0%]），术后发现（138 例[76.2%]），需要进一步手术（139 例[76.8%]）。许多患者遭受严重伤害（55 例[30.4%]）或死亡（25 例[13.8%]）。非妇科案例中的同行专家比妇科案例中的同行专家更有可能在医疗事故中对医生进行批评（79 例[71.2%]比 30 例[42.9%]，p<0.01）。同行专家的批评往往涉及临床评估、决策和解剖结构的错误识别。对非技术技能的批评则发现了文件记录和沟通方面的不足。
本研究证实了对提供者和团队进行培训以提高临床评估和决策、文件记录和沟通的重要性。有效的方案可能有助于支持临床医生提供更安全的手术护理。
