Medico-legal claims in colorectal surgery: Analysis of 231 files.

PURPOSE OF THE STUDY: The patient undergoing surgery is at risk of complications, some of which can be serious; these can expose the surgeon or institution to claims for compensation of damages. The aim of this study is to analyze the surgical management of these situations in order to draw lessons, to improve the management of patients, and to prevent both complications and resulting claims. PATIENTS AND METHODS: Two visceral surgeons analyzed two hundred and thirty-one claims files. The patient's characteristics and data, the intervention, the source event of the claim, re-interventions, transfers, deaths and their causes were identified. Any error, whether it was identified by the expert or by the arbitration panel or court and vice versa was analyzed, including any amicable out-of-court agreement proposed by the insurance, even, if in certain cases, no real fault had been found. RESULTS: The mean age of the colon surgery patients was 62 years. The pathologies for which surgery was performed fell into three equal parts: colon cancer, sigmoid diverticulitis, and other pathologies. The event leading to the claim occurred during hospitalization in 69.2% of cases. The most common events prompting claims were anastomotic leak (34.1%) and injury to neighboring organs (16.4%). In 36.7% of cases, patients required transfer to another facility and 31.1% died. At least one fault or error was found in 46.8% of cases. Anastomotic leak has always been considered an inherent risk of colonic surgery. The main fault alleged was delay in management in nearly two out of three cases, including delays in communication, in physical and laboratory examination, medical treatment, re-operation, and transfer. CONCLUSION: Specific information was provided to the patient before surgery and an effective checklist to prevent complaints and complications. In the post-operative period, an active approach to management initiated without delay by the entire team when faced with any unexpected event favored a quick recovery and could avoid the complaints; exams, sometimes lacking, remain complementary as their names indicate.

MRI-based measurements of aerosol deposition in the lung of healthy and elastase-treated rats.

Aerosolized drugs are increasingly being used to treat chronic lung diseases or to deliver therapeutics systemically through the lung. The influence of disease, such as emphysema, on particle deposition is not fully understood. With the use of magnetic resonance imaging (MRI), the deposition pattern of iron oxide particles with a mass median aerodynamic diameter of 1.2 µm was assessed in the lungs of healthy and elastase-treated rats. Tracheostomized rats were ventilated with particles, at a tidal volume of 2.2 ml, and a breathing frequency of 80 breaths/min. Maximum airway pressure was significantly lower in the elastase-treated (Paw = 7.71 ± 1.68 cmH2O) than in the healthy rats (Paw = 10.43 ± 1.02 cmH2O; P < 0.01). This is consistent with an increase in compliance characteristic of an emphysema-like lung structure. Following exposure, lungs were perfusion fixed and imaged in a 3T MR scanner. Particle concentration in the different lobes was determined based on a relationship with the MR signal decay rate, R2 (*). Whole lung particle deposition was significantly higher in the elastase-treated rats (CE,part = 3.03 ± 0.61 µm/ml) compared with the healthy rats (CH,part = 1.84 ± 0.35 µm/ml; P < 0.01). However, when particle deposition in each lobe was normalized by total deposition in the lung, there was no difference between the experimental groups. However, the relative dispersion [RD = standard deviation/mean] of R2 (*) was significantly higher in the elastase-treated rats (RDE = 0.32 ± 0.02) compared with the healthy rats (RDH = 0.25 ± 0.02; P < 0.01). These data show that particle deposition is higher and more heterogeneously distributed in emphysematous lungs compared with healthy lungs.