Department of Orthopedic Surgery, Institut Mutualiste Montsouris, 42 Boulevard Jourdan, 75014, Paris, France.
Department of Orthopedics and Traumatology, Pitié-Salpêtrière Hospital, AP-HP, Sorbonne University, 47-83 Boulevard de l'Hôpital, 75013, Paris, France.
Knee Surg Sports Traumatol Arthrosc. 2021 Nov;29(11):3551-3559. doi: 10.1007/s00167-021-06586-9. Epub 2021 Apr 25.
The objective of this study was to determine the reasons for complaints and describe the judicial means upstream of France's courts following arthroscopy.
This is a retrospective observational study including all compensation records related to arthroscopic surgery, collected from the two leading French insurance organizations: MACSF and Branchet companies, from 2014 to 2018. Three medical experts performed the protocol and analysis.
Finally, 247 procedures were included. The most common motives were: the appearance or persistence of pain (43.7%), postoperative infection (29.1%), technical errors (10.5%), nerve damage (5.7%), arterial lesions (2.8%), side errors (2.4%). Knee arthroscopies were more at risk of legal action for infection (p = 0.0006), and for disappointing results or persistent pain (p = 0.001). The first recourse was the conciliation and compensation commission (CCI) in 136 cases (55.1%), the civil court (TGI) in 88 cases (35.6%) and amicable settlement in 23 cases (9.3%). The mean time between surgery and the complaint was 32.8 ± 25.7 months, and was shorter in the case of an amicable procedure (p < 0.001). The lawsuit's mean duration was 15.6 ± 11.2 months, but longer in case of civil proceedings (p < 0.0001). The experts found no negligence in 81.8% of cases (n = 202). Infections were the leading cause of recourse to the conciliation and compensation commission (p < 0.0001), while technical errors were the main reason for complaints settled in an amicable procedure (p = 0.035). It was found more proven negligence in case of amicable procedures (p < 0.0001). The mean amount of compensation was 60,968.45€. No significant difference could be found regarding the median values of compensation between the reason of complaint. The amount of compensation was higher in civil court proceedings than in any others (p = 0.02).
The main reasons for arthroscopy litigation in France are reported in this study, specifying how they are managed upstream of possible legal proceedings. The knee is the main joint involved. Patient information, close follow-up associated with early and appropriate management of complications are the main ways to reduce complaints.
IV.
本研究旨在确定关节镜检查后法国法院受理投诉的原因，并描述其司法程序。
这是一项回顾性观察研究，纳入了自 2014 年至 2018 年期间从法国两大保险机构（MACSF 和 Branchet 公司）收集的所有与关节镜手术相关的赔偿记录。由三位医学专家执行方案和分析。
最终纳入 247 例手术。最常见的投诉原因是：疼痛出现或持续（43.7%）、术后感染（29.1%）、技术失误（10.5%）、神经损伤（5.7%）、动脉损伤（2.8%）、手术失误（2.4%）。膝关节镜手术更易因感染（p=0.0006）和结果不佳或持续疼痛（p=0.001）而引发法律诉讼。136 例（55.1%）首先通过和解与赔偿委员会（CCI）解决，88 例（35.6%）诉诸民事法庭（TGI），23 例（9.3%）通过庭外和解解决。手术至投诉的平均时间为 32.8±25.7 个月，庭外和解的时间更短（p<0.001）。诉讼的平均持续时间为 15.6±11.2 个月，但民事诉讼时间更长（p<0.0001）。81.8%（n=202）的案例中专家未发现过失。感染是诉诸和解与赔偿委员会（CCI）的主要原因（p<0.0001），而技术失误是庭外和解的主要原因（p=0.035）。庭外和解更易被认定存在过失（p<0.0001）。赔偿中位数无明显差异。民事诉讼的赔偿金额高于其他程序（p=0.02）。
本研究报告了法国关节镜诉讼的主要原因，并详细说明了这些原因在可能的法律程序之前是如何处理的。膝关节是最常受累的关节。患者信息、密切随访以及早期和适当处理并发症是减少投诉的主要方法。
IV。
