Subject(s)
Prostheses and Implants/statistics & numerical data , Registries/statistics & numerical data , Data Collection/legislation & jurisprudence , Data Collection/standards , Data Collection/statistics & numerical data , Germany , Humans , Prostheses and Implants/standards , Prosthesis Failure/etiology , Quality Assurance, Health Care/legislation & jurisprudence , Quality Assurance, Health Care/statistics & numerical data , Registries/standards , Reoperation/legislation & jurisprudence , Reoperation/standards , Reoperation/statistics & numerical data , Societies, MedicalABSTRACT
BACKGROUND: In recent years, the incidence of overweight and obesity has increased in the German population. Thus the number of obese patients treated with primary total joint arthroplasty has also increased. It is therefore predicted that the number of obese patients undergoing revision total joint arthroplasty will also increase. Nevertheless almost every manufacturer of commercially available revision arthroplasty implants states in his product safety guarantee that obesity is a relative or absolute contraindication. Data on revision total joint arthroplasty in obese patients are sparse. The aim of this systematic review is to assess the current literature on re-revision rate, infection rate, postoperative clinical outcome, and implant survival rate in obese patients undergoing revision total knee arthroplasty. Moreover, potential legal consequences and aspects are discussed which are essential for the surgeon. MATERIAL AND METHODS: We conducted a systematic review of the online databases PubMed and identified clinical studies on obesity and overweight in revision total knee arthroplasty. Study quality was assessed using levels of evidence and the modified Jadad score. We also included descriptive data on case numbers, age, gender, height, weight and follow-up time. Current legal aspects were also analysed. RESULTS/DISCUSSION: Five studies met the inclusion criteria and were included in the systematic review. The average Jadad score was 1, the average level of evidence 3. In two studies, infection and revision occured more often in obese patients. Patients with morbid obesity had a higher risk of wound revision and periprosthetic joint infections. Three studies showed that obese patients had significantly lower scores for clinical outcome measures in function and pain. The legal aspect was not discussed in any of the five studies. Overall, published data are sparse and very heterogeneous. Therefore comparing these five studies is difficult. However, the results of our review suggest that obesity in revision total knee arthroplasty may have a negative influence on reoperation rate, infection rate and postoperative functional outcome. From a legal point of view, potential weight limitations of the implants intented for use have to be part of the oral preoperative discussion. The patient's informed consent has to be received and documented prior to revision total joint arthroplasty.
Subject(s)
Arthroplasty, Replacement, Knee/legislation & jurisprudence , Arthroplasty, Replacement, Knee/methods , Malpractice/legislation & jurisprudence , Obesity/complications , Postoperative Complications/surgery , Reoperation/legislation & jurisprudence , Reoperation/methods , Adolescent , Adult , Aged , Body Mass Index , Equipment Failure Analysis , Female , Humans , Male , Middle Aged , Obesity/physiopathology , Pain, Postoperative/etiology , Pain, Postoperative/surgery , Postoperative Complications/etiology , Risk Factors , Surgical Wound Infection/etiology , Surgical Wound Infection/surgery , Young AdultABSTRACT
BACKGROUND: Although investigations of retrieved medical implants can provide valuable information about the cause of the revision, there is a lack of information, which could be avoided by consequent failure analyses. In the framework of the EndoCert certification system it is obligatory to record and report incidents. OBJECTIVES: The present work examines how the willingness to report has developed in certified arthroplasty centers and which method of handling retrievals is preferred and actually used. MATERIALS AND METHODS: On the basis of a questionnaire for handling retrievals, all 508 arthroplasty centers that were certified till June 1, 2016, were included (return rateâ¯= 97.2%). RESULTS: A total of 93.3% of the centers have established an algorithm for handling of retrievals and 83.0% of the centers prefer to hand out the retrieval to the patient, while only 25.7% wish to store it in the center for research purposes. In the case of a potential incident as the cause of revision, centers prefer to forward the retrieval to damage analysis, whereby the centers act in different ways, depending on the case. An implant fracture is, e.g., considered a reportable event in most cases without temporal limitation. On the other hand, breakage or failure of surgical instruments is considered not to be reported in the case of more than half of the centers. In 2014 and 2015, approximately 71% of EPZs reported no incidents. CONCLUSIONS: According to our survey, many certified arthroplasty centers are sensitized to careful handling of retrievals. The treatment of the explanted components is conducted in different ways. The assessment of whether an incident is to be reported shows large differences. In view of the relatively high number of revision surgeries, the number of reports to the authorities appears to be low.
Subject(s)
Algorithms , Arthroplasty, Replacement/instrumentation , Device Removal/legislation & jurisprudence , Prosthesis Failure , Arthroplasty, Replacement/legislation & jurisprudence , Device Approval/legislation & jurisprudence , Expert Testimony/legislation & jurisprudence , Germany , Humans , National Health Programs/legislation & jurisprudence , Prosthesis Failure/etiology , Reoperation/legislation & jurisprudence , Risk Management/legislation & jurisprudence , Surveys and QuestionnairesSubject(s)
Diagnostic Errors/legislation & jurisprudence , Expert Testimony/legislation & jurisprudence , Malpractice/legislation & jurisprudence , Melanoma, Amelanotic/pathology , Quality Assurance, Health Care/legislation & jurisprudence , Referral and Consultation/legislation & jurisprudence , Skin Neoplasms/pathology , Forearm/surgery , Germany , Guideline Adherence/legislation & jurisprudence , Humans , Male , Melanoma, Amelanotic/diagnosis , Melanoma, Amelanotic/surgery , Reoperation/legislation & jurisprudence , Sentinel Lymph Node Biopsy , Skin Neoplasms/diagnosis , Skin Neoplasms/surgery , Skin TransplantationABSTRACT
Alloplastic transvaginal meshes have become very popular in the surgery of pelvic organ prolapse (POP) as did alloplastic suburethral slings in female stress incontinence surgery, but without adequate supporting data. The simplicity of the mesh procedure facilitates its propagation with acceptance of higher revision and complication rates. Since attending physicians do more and more prolapse surgeries without practicing or teaching alternative techniques, expertise in these alternatives, which might be very useful in cases of recurrence, persistence or complications, is permanently lost. It is doubtful that proper and detailed information about alternatives, risks, and benefits of transvaginal alloplastic meshes is provided to every single prolapse patient according to the recommendations of the German POP guidelines, since the number of implanted meshes exceeds the number of properly indicated mesh candidates by far. Although there is no dissent internationally about the available mesh data, thousands of lawsuits in the USA, insolvency of companies due to claims for compensation and unambiguous warnings from foreign urological societies leave German urogynecologists still unimpressed. The existing literature in pelvic organ prolapse exclusively focusses on POP stage and improvement of that stage with surgical therapy. Instead, typical prolapse symptoms should trigger therapy and improvement of these symptoms should be the utmost treatment goal. It is strongly recommended for liability reasons to obtain specific written informed consent.
Subject(s)
Pelvic Floor Disorders/surgery , Polypropylenes , Surgical Mesh/adverse effects , Urinary Incontinence, Stress/surgery , Uterine Prolapse/surgery , Compensation and Redress/legislation & jurisprudence , Contraindications , Female , Germany , Humans , Informed Consent/legislation & jurisprudence , Malpractice/legislation & jurisprudence , Postoperative Complications/etiology , Postoperative Complications/surgery , Recurrence , Reoperation/legislation & jurisprudence , Risk Factors , United States , Urinary Incontinence, Stress/etiologySubject(s)
Cholecystectomy, Laparoscopic/adverse effects , Cholecystectomy, Laparoscopic/legislation & jurisprudence , Expert Testimony/legislation & jurisprudence , Malpractice/legislation & jurisprudence , Surgical Instruments/adverse effects , Aged , Cholecystectomy, Laparoscopic/instrumentation , Compensation and Redress/legislation & jurisprudence , Fatal Outcome , Female , Germany , Humans , Intestinal Perforation/etiology , Intestinal Perforation/surgery , Intestine, Small/injuries , Intestine, Small/surgery , Jejunostomy/adverse effects , Jejunostomy/legislation & jurisprudence , Multiple Organ Failure/etiology , Peritonitis/etiology , Peritonitis/surgery , Pneumoperitoneum, Artificial/adverse effects , Pneumoperitoneum, Artificial/instrumentation , Postoperative Complications/etiology , Postoperative Complications/surgery , Reoperation/legislation & jurisprudence , Shock, Septic/etiology , Shock, Septic/surgerySubject(s)
Malpractice/legislation & jurisprudence , Medical Errors/legislation & jurisprudence , Thyroid Gland/surgery , Zenker Diverticulum/surgery , Esophagoscopy , Female , Germany , Humans , Middle Aged , Reoperation/legislation & jurisprudence , Surgical Stapling , Thyroid Gland/pathology , Tomography, Spiral Computed , Zenker Diverticulum/diagnostic imaging , Zenker Diverticulum/pathologySubject(s)
Adenoma/surgery , Esophagectomy/legislation & jurisprudence , Esophagus/injuries , Expert Testimony/legislation & jurisprudence , Hyperparathyroidism, Secondary/surgery , Intraoperative Complications/surgery , Malpractice/legislation & jurisprudence , Medical Errors/legislation & jurisprudence , Parathyroid Neoplasms/surgery , Parathyroidectomy , Adult , Compensation and Redress/legislation & jurisprudence , Esophagus/surgery , Female , Gastrostomy/methods , Germany , Humans , Hyperparathyroidism, Secondary/etiology , Kidney Failure, Chronic/complications , Pharynx/surgery , Plastic Surgery Procedures/methods , Reoperation/legislation & jurisprudenceSubject(s)
Expert Testimony/legislation & jurisprudence , Hernia, Hiatal/diagnosis , Hernia, Hiatal/surgery , Malpractice/legislation & jurisprudence , Postoperative Complications/diagnosis , Postoperative Complications/surgery , Stomach/pathology , Compensation and Redress/legislation & jurisprudence , Conversion to Open Surgery , Female , Gastrectomy , Guideline Adherence/legislation & jurisprudence , Humans , Laparoscopy , Middle Aged , Necrosis/diagnosis , Necrosis/surgery , Reoperation/legislation & jurisprudenceSubject(s)
Expert Testimony/legislation & jurisprudence , Health Literacy/legislation & jurisprudence , Malpractice/legislation & jurisprudence , Arthroplasty, Replacement, Hip/legislation & jurisprudence , Debridement/legislation & jurisprudence , Female , Humans , Prosthesis-Related Infections/surgery , Reoperation/legislation & jurisprudenceSubject(s)
Abdomen, Acute/etiology , Colon/injuries , Colonic Polyps/surgery , Colonoscopy/adverse effects , Colonoscopy/legislation & jurisprudence , Expert Testimony/legislation & jurisprudence , Intestinal Perforation/etiology , Malpractice/legislation & jurisprudence , Medical Errors/legislation & jurisprudence , Postoperative Complications/etiology , Abdomen, Acute/diagnosis , Abdomen, Acute/surgery , Colectomy/legislation & jurisprudence , Delayed Diagnosis/legislation & jurisprudence , Diagnostic Errors/legislation & jurisprudence , Germany , Humans , Intestinal Perforation/diagnosis , Intestinal Perforation/surgery , Male , Middle Aged , Peritonitis/diagnosis , Peritonitis/etiology , Peritonitis/surgery , Postoperative Complications/diagnosis , Postoperative Complications/surgery , Reoperation/legislation & jurisprudence , Sepsis/diagnosis , Sepsis/etiology , Sepsis/surgeryABSTRACT
OBJECTIVES: Characterize factors raised in carotid endarterectomy litigation. METHODS: Outcomes, alleged causes of malpractice, and other factors were evaluated. RESULTS: Of the 37 verdicts and settlements, defendants were not liable in 25 (67.5%) cases. Frequently reported complications included stroke (51.3%) and hypoglossal nerve injury (27.0%), with other complications including airway compromise, vocal cord injury, and death. No cases reported myocardial infarction. Cerebral monitoring was mentioned in 2 cases, while inadequate informed consent, delayed diagnosis, and requirement of additional surgery were alleged in numerous instances. Settlements and jury awards averaged US$895 833 and US$1.53 million, respectively. CONCLUSIONS: Stroke and hypoglossal nerve injury are the most frequently litigated complications, and mean damages awarded were considerable. Knowledge of issues raised in our analysis may be included in a comprehensive consent process, potentially minimizing liability and improving patient safety.
Subject(s)
Endarterectomy, Carotid/adverse effects , Endarterectomy, Carotid/legislation & jurisprudence , Liability, Legal , Malpractice/legislation & jurisprudence , Medical Errors/legislation & jurisprudence , Postoperative Complications/etiology , Adult , Aged , Aged, 80 and over , Compensation and Redress , Delayed Diagnosis/legislation & jurisprudence , Endarterectomy, Carotid/economics , Female , Humans , Informed Consent/legislation & jurisprudence , Liability, Legal/economics , Male , Malpractice/economics , Medical Errors/economics , Middle Aged , Patient Safety , Postoperative Complications/economics , Postoperative Complications/surgery , Reoperation/legislation & jurisprudence , Risk Assessment , Risk Factors , Time Factors , Treatment OutcomeSubject(s)
Diverticulum, Colon/surgery , Expert Testimony/legislation & jurisprudence , Malpractice/legislation & jurisprudence , Minimally Invasive Surgical Procedures/adverse effects , Peritonitis/mortality , Peritonitis/surgery , Postoperative Complications/mortality , Postoperative Complications/surgery , Shock, Septic/mortality , Shock, Septic/surgery , Sigmoid Diseases/surgery , Adult , Diverticulum, Colon/mortality , Fatal Outcome , Germany , Humans , Male , Pancreatitis, Acute Necrotizing/diagnosis , Pancreatitis, Acute Necrotizing/mortality , Pancreatitis, Acute Necrotizing/surgery , Peritonitis/diagnosis , Postoperative Complications/diagnosis , Reoperation/legislation & jurisprudence , Shock, Septic/diagnosis , Sigmoid Diseases/mortality , Surgical Wound Dehiscence/diagnosis , Surgical Wound Dehiscence/mortality , Surgical Wound Dehiscence/surgery , Tomography, X-Ray ComputedSubject(s)
Adenoidectomy/legislation & jurisprudence , Ambulatory Surgical Procedures/legislation & jurisprudence , Carotid Artery Injuries/etiology , Carotid Artery, Internal , Expert Testimony/legislation & jurisprudence , Intraoperative Complications/etiology , Malpractice/legislation & jurisprudence , Child, Preschool , Clinical Competence/legislation & jurisprudence , Compensation and Redress/legislation & jurisprudence , Fatal Outcome , Female , Germany , Humans , Licensure, Medical/legislation & jurisprudence , National Health Programs/legislation & jurisprudence , Reoperation/legislation & jurisprudenceABSTRACT
Within the last years aesthetic surgery enjoys greater popularity and acceptance. One of the most frequently asked operations has been the aesthetic rhinoplasty. Hardly any other field of surgery is exposed to such a critical analysis than aesthetic rhinoplasty because the results are so obvious. According to the "International Society of Aesthetic Surgery" (ISAPS) over 980 000 cosmetic rhinoplasties have been performed in 2010. This corresponds to 10.4% of all registered aesthetic procedures worldwide. Complications can not be eliminated in such a large number of nasal operations. Up to 15% of all patients re-consult a doctor for a revision because they are dissatisfied with their final rhinoplasty result. Findings of the tip followed by functional problems and irregularities of the nasal dorsum are named most frequently. The responsible rhinosurgeon has to regard all anatomical and physiological details and to consider ethical and psychological aspects in the preselection and postoperative care of the patient. Aesthetic surgeons should be acquainted with terms and definitions like body image, dysmorphophobia or Thersites complex. Acronyms, like "SIMON" or "SYLVIA", support the physician additionally to analyze and assess the patient. The following article describes the most frequent faults, complications and pitfalls after aesthetic rhinoplasty listed by the anatomical structure. Results will be analyzed, strategies and techniques will be suggested to correct the faults and to prevent them in the future. Furthermore psychologic, social and psychiatric aspects will be discussed and handling with aesthetic patients explained.
Subject(s)
Blepharoplasty/adverse effects , Ear, External/surgery , Malpractice/legislation & jurisprudence , Medical Errors/legislation & jurisprudence , Postoperative Complications/etiology , Rhinoplasty/adverse effects , Surgery, Plastic/adverse effects , Surgery, Plastic/legislation & jurisprudence , Adolescent , Adult , Blepharoplasty/psychology , Ear, External/abnormalities , Female , Germany , Humans , Male , Medical Errors/psychology , Middle Aged , Patient Satisfaction/legislation & jurisprudence , Physician-Patient Relations , Postoperative Complications/prevention & control , Postoperative Complications/psychology , Postoperative Complications/surgery , Reoperation/legislation & jurisprudence , Reoperation/psychology , Rhinoplasty/psychology , Surgery, Plastic/psychology , Turbinates/surgery , Young AdultSubject(s)
Breast Neoplasms/surgery , Esthetics , Expert Testimony/legislation & jurisprudence , Free Tissue Flaps , Informed Consent/legislation & jurisprudence , Malpractice/legislation & jurisprudence , Mammaplasty/legislation & jurisprudence , Neoplasms, Second Primary/surgery , Patient Satisfaction , Postoperative Complications/etiology , Reoperation/legislation & jurisprudence , Female , Germany , Humans , Mental Competency/legislation & jurisprudence , Postoperative Complications/surgery , Tissue and Organ HarvestingSubject(s)
Athletic Injuries/surgery , Bicycling/injuries , Device Removal/instrumentation , Expert Testimony/legislation & jurisprudence , Fracture Fixation, Intramedullary/instrumentation , Fractures, Spontaneous/etiology , Hip Fractures/etiology , Hip Fractures/surgery , Malpractice/legislation & jurisprudence , Postoperative Complications/etiology , Postoperative Complications/surgery , Bone Screws/adverse effects , Compensation and Redress/legislation & jurisprudence , Device Removal/adverse effects , Fracture Fixation, Intramedullary/adverse effects , Germany , Humans , Male , Middle Aged , Recurrence , Reoperation/legislation & jurisprudenceABSTRACT
In very rare cases, a complex regional pain syndrome type I (CRPS I) of the hand can take a serious, chronic, incurable course. We describe the case of a 36-year-old patient who after reconstruction of a scaphoid fracture developed such a condition. 9 years after the operation an amputation of the hand was performed at the request of the patient after various expert opinions had been obtained and legal action against the insurance provider was successfully concluded. Amputation of the hand can be discussed as a last resort for relief of suffering in cases of severe CRPS I.
Subject(s)
Amputation, Surgical , Fractures, Bone/surgery , Hand/surgery , Postoperative Complications/surgery , Pseudarthrosis/surgery , Reflex Sympathetic Dystrophy/surgery , Scaphoid Bone/injuries , Adult , Amputation, Surgical/legislation & jurisprudence , Casts, Surgical , Combined Modality Therapy , Expert Testimony/legislation & jurisprudence , Follow-Up Studies , Fracture Fixation, Internal/adverse effects , Humans , Hyperalgesia/surgery , Male , Patient Satisfaction , Postoperative Care , Reoperation/legislation & jurisprudence , Treatment FailureABSTRACT
Incidents involving implants, whether there is a break in the osteosynthesis plate or a synthetic inlay of an endoprosthesis, are incidents with mostly severe repercussions for the patient with immediate and delayed effects for the clinic involved and the manufacturer.