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Insurance Claims after Vascular Surgery in Sweden
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
2011 (English)In: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, E-ISSN 1532-2165, Vol. 42, no 4, 495-505 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES:

The study aimed to estimate the incidence and causes of insurance claims (IC) after vascular surgery (VS) reported to the Swedish Medical Injury Insurance (SMII); and to validate the registration of complications in the National Vascular Registry (Swedvasc).

METHODS:

The medical records of all IC in VS in Sweden reported to the SMII 2002-2007 were scrutinised and cross-referenced against Swedvasc.

RESULTS:

There were 193 claims after VS: varicose-veins (66), lower extremity (45), aortic (31) or carotid artery (21), access (19) or other VS (11). Frequent causes of claims were peripheral nerve injury (76), wound infection (22) and cranial nerve injury (15). More than half of the patients suffered permanent injuries, three died. As many as 55 (28%) received economic compensation (an average of 45% of all ICs in SMII). The highest frequency of compensated claims (1:650 yearly procedures) was for carotid artery surgery. Of the procedures, 187 were elective. Compared with the Swedvasc, claudication was a more common indication (28% vs. 12%). Nearly one-fifth (18%) were incorrectly registered in Swedvasc.

CONCLUSIONS:

The most common causes of insurance claims were peripheral nerve injuries and infections. Patients raising insurance claims after vascular surgery undergo acute procedures less frequently, and are correctly registered in the Swedvasc in 82% of cases.

Place, publisher, year, edition, pages
2011. Vol. 42, no 4, 495-505 p.
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-157170DOI: 10.1016/j.ejvs.2011.04.026ISI: 000296042600019PubMedID: 21669541OAI: oai:DiVA.org:uu-157170DiVA: diva2:435392
Available from: 2011-08-18 Created: 2011-08-18 Last updated: 2017-12-08Bibliographically approved
In thesis
1. Iatrogenic Vascular Injuries
Open this publication in new window or tab >>Iatrogenic Vascular Injuries
2013 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Iatrogenic vascular injuries (IVIs) and injuries associated with vascular surgery can cause severe morbidity and death. The aims of this thesis were to study those injuries in the Swedish vascular registry (Swedvasc), the Swedish medical injury insurance where insurance claims are registered, the Population and Cause of death registries, and in patient records, in order to explore preventive strategies.

Among 87 IVIs during varicose vein surgery 43 were venous, mostly causing bleeding in the groin. Among 44 arterial injuries, only 1/3 were detected intraoperatively. Accidental arterial stripping predominated, with poor outcome. Four patients died, all after venous injuries.

IVIs increased over time, and constitute more than half of the vascular injuries registered in the Swedvasc. Lethal outcome was more common (4.9%) among patients suffering IVIs than among non-iatrogenic vascular injuries (2.5%). Risk factors for death were age, diabetes, renal insufficiency and obstructive lung-disease.

Fifty-two patients died within 30 days after IVI. The most common lethal IVIs were puncture during endovascular procedures (n=24, 46%), penetrating trauma during open surgery (11) and occlusion after compression (6). Symptoms were peripheral ischemia (n=19), external bleeding (14), and hypovolemic chock without external bleeding (10). Most died within two weeks (n=36, 69%). After >2 weeks the IVI as a cause of death was uncertain.

Among 193 insurance claims after vascular surgery during 2002-2007, nerve injuries (91) and wound infections (22) dominated. Most patients suffered permanent injuries, three died. Patients with insurance claims were correctly registered in the Swedvasc in 82%.

In 32 cases of popliteal artery injury during knee arthroplasty symptoms were bleeding (n=14), ischaemia (n=7) and false aneurysm formation (n=11). Only twelve injuries (38%) were detected intraoperatively. Patency at 30 days was 97%, but only seven (22%) patients had complete recovery. Six of those had intraoperative diagnosis of popliteal injury and immediate vascular repair.

In conclusion, registration of IVIs is increasing and outcome is often negatively affected by diagnostic and therapeutic delay. Not all fatalities after IVIs are attributable to the injury itself. The most common causes of insurance claims after vascular surgery were nerve injuries, and 82% were correctly registered in Swedvasc.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2013. 63 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 867
Keyword
vascular injuries, vascular surgery, vascular trauma, injury, medical error, patient safety, postoperative death, postoperative mortality, patient insurance, varicose veins
National Category
Surgery
Research subject
Surgery
Identifiers
urn:nbn:se:uu:diva-194346 (URN)978-91-554-8597-9 (ISBN)
Public defence
2013-04-12, Auditorium Minus, Museum Gustavianum, Akademigatan 3, Uppsala, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2013-03-22 Created: 2013-02-12 Last updated: 2013-04-02Bibliographically approved

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Rudström, HåkanBergqvist, DavidBjörck, Martin

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