Department of Surgery, Yale School of Medicine, New Haven, Connecticut.
School of Medicine, University of California, Los Angeles, California.
Surg Obes Relat Dis. 2022 Jul;18(7):943-947. doi: 10.1016/j.soard.2022.04.004. Epub 2022 Apr 21.
Bariatric surgery has demonstrated sustained improvements in quality. Malpractice closed claims have been offered as a means of assessing quality. Few studies have investigated malpractice closed claims and opportunities for improvement in bariatric surgery.
To examine the prevalence and causes of malpractice claims with examination of prospects for quality improvement.
University hospital, United States; private practice.
Four national malpractice insurers participated in the closed-claims registry. Data regarding patients, staff, procedures, and hospital status were gathered from closed-claims files. Following data collection, a clinical summary of each closed claim was collected and later assessed by an expert panel on the basis of the following: contributing diagnosis and treatment events; whether complications were potentially preventable by the surgeon; the role of language, fatigue, distraction, workload, or teaching hospital/trainee supervision; communication concerns; and final care determination.
A total of 175 closed claims were collected from index bariatric surgeries within the period from 2006-2014. Of these, 75.9% of surgeons were board certified and 43.3% of the hospitals were accredited for bariatric surgery. Most clinical complications after bariatric surgery that led to malpractice lawsuits were mortality (35.1%) and leaks (17.5%). While they were not the common cause for malpractice suits, bleeding (5.3%), retained foreign body (5.3%), and vascular injury (4.4%) occurred at higher rates than national averages.
Prevalence of malpractice claims regarding bariatric surgery is low. Failure to diagnose, delay in treatment, postoperative care, and communication domain responses indicate future opportunities for improvement.
减重手术已被证实可持续改善生活质量。医疗事故理赔案例已被作为评估医疗质量的一种手段。然而，仅有少数研究调查了减重手术的医疗事故理赔案例和改进机会。
调查医疗事故理赔的发生率和原因，并探讨质量改进的机会。
美国的一家大学医院和一家私人诊所。
四家全国性的医疗事故保险公司参与了这项闭案注册研究。从闭案档案中收集有关患者、医护人员、手术过程和医院状况的数据。在数据收集完成后，根据以下标准，由一个专家小组对每份闭案索赔进行临床总结和评估：促成诊断和治疗事件；并发症是否可能因外科医生而得到预防；语言、疲劳、注意力分散、工作量或教学医院/受训医生监管的作用；沟通问题；以及最终护理决策。
在 2006 年至 2014 年期间，共从索引减重手术中收集了 175 例闭案。其中，75.9%的外科医生持有委员会认证，43.3%的医院接受过减重手术认证。导致医疗事故诉讼的减重手术后最常见的并发症是死亡率（35.1%）和漏诊（17.5%）。虽然这些并非医疗事故诉讼的常见原因，但出血（5.3%）、遗留异物（5.3%）和血管损伤（4.4%）的发生率高于全国平均水平。
与减重手术相关的医疗事故理赔发生率较低。未能诊断、延迟治疗、术后护理和沟通领域的反应表明存在未来改进的机会。
