Intraoperative injuries from abdominopelvic surgery: an analysis of national medicolegal data
Guylaine Lefebvre1, Kirsten A Devenny1, Diane L Héroux1
1From Practice Improvement, Canadian Medical Protective Association, Ottawa, Ont. (Lefebvre, Mimeault); Medical Care Analytics, Canadian Medical Protective Association, Ottawa, Ont. (Devenny, Héroux, Bowman, Neilson, Calder); the Department of Obstetrics and Gynecology, University of Ottawa, Shirley E. Greenberg Women's Health Centre, Ottawa, Ont. (Singh); and the Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ont. (Calder).
Background:
Intraoperative injuries during abdominopelvic surgery can be associated with substantial patient harm. The objective of this study was to describe abdominopelvic intraoperative injuries and their contributing factors among medicolegal cases.
Methods:
This study was a descriptive analysis of medicolegal matters reported to a national body, with subgroup analyses by type of surgery. We reviewed medicolegal matters involving a population-based sample of physicians who were subject to a civil legal action or complaint to a regulatory authority that was closed between 2013 and 2017 in Canada.
Results:
Our analysis included 181 civil legal cases and 88 complaints to a regulatory authority. Among legal cases, 155 patients (85.6%) (median age 47 yr) underwent elective procedures. The most common injury site was the bowel (53 cases [29.3%]). Injuries frequently occurred during dissection (79 [43.6%]) and ligation (38 [21.0%]), were identified postoperatively (138 [76.2%]) and necessitated further surgery (139 [76.8%]). Many patients experienced severe harm (55 [30.4%]) or died (25 [13.8%]). Peer experts in nongynecologic cases were more likely than those in gynecologic cases to include criticisms of a provider in a harmful incident (79 [71.2%] v. 30 [42.9%], p < 0.01). Peer expert criticisms often related to clinical evaluation, decision-making and misidentification of anatomy. Criticisms of nontechnical skills identified documentation and communication deficiencies.
Conclusion:
This study confirms the importance of provider and team training to improve clinical evaluation and decision-making, documentation and communication. Effective protocols may help support clinicians in providing safer surgical care.
