Well Leg Compartment Syndrome After Abdominal Surgery.

BACKGROUND: Well leg compartment syndrome (WLCS) is a complication to abdominal surgery. We aimed to identify risk factors for and outcome of WLCS in Denmark and literature. METHODS: Prospectively collected claims to the Danish Patient Compensation Association (DPCA) concerning WLCS after abdominal operations 1996-2013 and cases in literature 1970-2013 were evaluated. Cases of fasciotomy within 2 weeks after abdominal surgery 1999-2008 were extracted from the Danish National Patient Register (DNPR). RESULTS: There were 40 cases in DPCA and 124 in literature. In 68 % legs were supported under the knees during surgery. Symptoms of WLCS presented within 2 h after surgery in 56 % and in only 3 cases after 24 h. Obesity was not confirmed as risk factor for WLCS. The mean diagnostic delay was 10 h. One-third of fasciotomies were insufficient. The diagnostic delay increased with duration of the abdominal surgery (p = 0.04). Duration of the abdominal surgery was 4 times as important as the diagnostic delay for severity of the final outcome. DNPR recorded 4 new cases/year, and half were reported to DPCA. CONCLUSION: The first 24 h following abdominal surgery of >4 h' duration with elevated legs observation for WLCS should be standard. Pain in the calf is indicative of WLCS, and elevated serum CK can support the diagnosis. Mannitol infusion and acute four-compartment fasciotomy of the lower leg is the treatment. The risk of severe outcome of WLCS increases with duration of the primary operation. A broad support and change of legs' position during surgery are suggested preventative initiatives.

Analysis of deaths among children in the period 1996-2008 from closed claims registered by the Danish Patient Insurance Association.

AIM: We investigated the death circumstances among children in the Danish healthcare system by analysing closed claims. METHODS: This retrospective study investigated closed claims with regard to medically related deaths registered by the Danish Patient Insurance Association. RESULTS: From 1996 to 2008, 45 953 claims were made to the Danish Patient Insurance Association (DPIA) covering all medical specialties. Among these claims, a total of 3531 submitted claims were for children younger than 18 years old, and 74 of these children were registered as having died. Forty-one of the 74 deaths were caused by peripartum asphyxia or other birth-related reasons, and 33 children died of causes not related to their birth. Twenty-three of the 33 children died as a result of substandard treatment. This was the ruling of the DPIA or the courts of law on the claim. In these cases, the DPIA, the appeal board or the courts of law settled that an experienced specialist would have acted differently such that the injury could have been avoided. CONCLUSION: Twenty-three of the 33 deaths after the perinatal period could potentially have been avoided if experienced specialists had handled the cases.

Analysis of 136 ureteral injuries in gynecological and obstetrical surgery from completed insurance claims.

OBJECTIVE: Iatrogenic ureteral injury during pelvic surgical procedures is a well-known complication and important cause of morbidity. The authors investigated the circumstances surrounding registered ureteral injuries in order to identify potential opportunities to prevent such injuries. DESIGN: Evaluation of claims concerning ureteral injuries reported to the Danish Patient Insurance Association. SETTING: Danish Patient Insurance Association. SAMPLE: All registered claims for ureteral injuries from 1996 to 2006. METHODS: Retrospective study of medical records and data from Danish Patient Insurance Association. MAIN OUTCOME MEASURES: Preventable ureteral injuries. RESULTS: From 1996 to 2006, 136 submitted claims concerning ureteral injuries were registered. Among these, 73 claims were approved (54%), and compensation paid. In 44 of these, the injury was caused by negligence. Failure to dissect the ureter despite indications for this procedure was the most common type of negligence. Laparotomy procedures were associated with 107 injuries (79%) and 29 injuries (21%) were caused during laparoscopic procedures. Thirty-four patients suffered from chronic renal dysfunction on the affected side. Only 17 of the ureteral injuries were discovered during the procedure. CONCLUSIONS: Forty-four ureteral injuries could potentially have been avoided using established surgical practices, most importantly by exposing the ureter via dissection when indicated. Most of the ureteral injuries were discovered postoperatively.

[Hypoxic brain injuries notified to the Danish Patient Insurance Association during 1992-2004. Secondary publication]. / Asfyksiskader anmeldt til Patientforsikringen i perioden 1992-2004--sekundaerpublikation.

We investigated the files of the Danish Patient Insurance Association for newborns suffering from hypoxic brain injuries. From 1992 to 2004, a total of 127 approved claims concerning peripartum hypoxic injury were registered. Thirty-eight newborns died and the majority of the 89 surviving children suffered major handicaps, primarily cerebral palsy. In 69 of the cases, misinterpretation of or late action in response to an abnormal cardiotocography caused the hypoxic brain injuries. All injuries could potentially have been avoided using established obstetric practice.

Analysis of 127 peripartum hypoxic brain injuries from closed claims registered by the Danish Patient Insurance Association.

BACKGROUND: One of the most feared complications in medicine is hypoxic brain damage to a newborn. The authors investigated the circumstances of registered peripartum hypoxic brain injuries in order to identify potential opportunities to improve patient safety and prevent injuries. METHODS: The authors retrospectively investigated peripartum hypoxic brain injuries registered by the Danish Patient Insurance Association. RESULTS: From 1992 to 2004, 127 approved claims concerning peripartum hypoxic brain injuries were registered and subsequently analysed. Thirty-eight newborns died, and a majority of the 89 surviving children suffered from major handicaps, primarily cerebral palsy. In 69 of the cases, misinterpretation of or late action on an abnormal cardiotocography (CTG) were the reasons for the majority of the hypoxic brain injuries. CONCLUSIONS: All injuries could potentially have been avoided using established obstetric practice. CTGs are often misinterpreted. In the authors' opinion, education and training in CTG interpretation is essential. The use of ST-analysis of the fetus ECG (STAN) could probably reduce the number of these injuries.

[Closed claims analysis of deaths related to anesthesia in the period 1996-2004 registered by the Danish Patient Insurance Association]. / Anaestesirelaterede dødsfald anmeldt til Patientforsikringen i perioden 1996-2004--sekundaerpublikation.

We investigated the Danish Patient Insurance Association's files on patients registered as dead after a complication to anaesthesia. In 24 cases the patient's death was considered to result from the anesthetic procedure: six deaths were related to airway or ventilation management, four to central venous catheter placement, four as a result of medication errors, four from infusion pump problems and four after complications from regional blockades. Severe hemorrhage caused one death, and in one case the cause was uncertain. Several of the 24 deaths could potentially have been avoided.

Analysis of deaths related to anesthesia in the period 1996-2004 from closed claims registered by the Danish Patient Insurance Association.

BACKGROUND: Anesthesia is associated with complications, and some of them may be fatal. The authors investigated the circumstances under which deaths were associated with anesthesia. In Denmark, the specialty anesthesiology encompasses emergency medicine, chronic and acute pain medicine, anesthetic procedures, perioperative care medicine, and intensive care medicine. METHODS: The authors retrospectively investigated anesthesia related deaths registered by the Danish Patient Insurance Association. RESULTS: From 1996 to 2004, 27,971 claims were made by the Danish Patient Insurance Association covering all medical specialties, of which 1,256 files (4.5%) were related to anesthesia. In 24 cases, the patient's death was considered to result from the anesthetic procedure: 4 deaths were related to airway management, 2 to ventilation management, 4 to central venous catheter placement, 4 as a result of medication errors, 4 from infusion pump problems, and 4 after complications from regional blockades. Severe hemorrhage caused 1 death, and in 1 case the cause was uncertain. CONCLUSIONS: Several of the 24 deaths could potentially have been avoided by more extended use of airway algorithm, thorough preoperative evaluation, training, education, and use of protocols for diagnosis and treatment.

[Patient injuries in response to anaesthetic procedures: cases evaluated by the Danish Patient Insurance Association--secondary publication]. / Anaestesiskader anmeldt til Patientforsikringen i perioden 1996-2002--sekundaerpublikation.

We investigated the Danish Patient Insurance Association files of patients, who were given financial compensation, because of an injury caused by an anaesthetic procedure. In the six-year-period 1996-2002, 374 patients were compensated in total 8.0 million euros for an injury caused by an anaesthetic procedure. Some anaesthetic complications may result in severe disability, whereby the financial compensation to the suffering patients is high. We estimate that approximately 0.2 per 1,000 of all patients receiving anaesthesia may develop complications that entitle them to financial compensation.