Malpractice in Surgery (eBook)

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Michael Imhof, Office for Medical and Scientific Expert Assessments, Würzburg, Germany.

Preface 9
Abbreviations 11
1 Principles of medical malpractice 15
1.1 Introduction 15
1.2 Notes concerning the history of medical malpractice 15
1.3 Defining malpractice 18
1.4 Statistical surveys 20
1.5 Summary 25
2 Errors, incidents and complications in general surgery 29
2.1 Introduction 29
2.2 Medical errors in laparoscopic cholecystectomy 29
2.2.1 Historical remarks 29
2.2.2 Statistics for medical complications 30
2.2.3 Complications specific to laparoscopic cholecystectomy 31
2.2.4 Surgical procedure, and possible causes of errors 34
2.2.5 Medical malpractice litigation after laparoscopic cholecystectomy 35
2.2.6 Informed consent 39
2.2.7 Real-life examples 39
2.2.8 Summary 41
2.3 Risks and possible errors related to minimally invasive or laparoscopic surgery 41
2.3.1 Introduction 41
2.3.2 Fundamentals underlying the technical standard and potential errors 41
2.3.3 Real-life examples 45
2.3.4 Summary 47
2.4 Complications and possible errors in inguinal hernia treatment 47
2.4.1 Introduction 47
2.4.2 Fundamentals of inguinal hernia surgery 48
2.4.3 Informed consent 49
2.4.4 Intra- and postoperative errors and complications 49
2.4.5 Real-life examples 52
2.4.6 Summary 54
2.5 Complications and errors in the surgical treatment of benign thyroid disorders 55
2.5.1 Introduction 55
2.5.2 Fundamentals of the surgical treatment of struma 55
2.5.3 Informed consent 56
2.5.4 Remarks concerning the surgical technique 56
2.5.5 Technical errors and complications 58
2.5.6 Prospects for new minimally invasive techniques 58
2.5.7 Real-life examples 59
2.5.8 Summary 60
2.6 Complications and errors arising in the diagnostics and treatment of acute appendicitis 60
2.6.1 Introduction 60
2.6.2 Fundamentals 60
2.6.3 Remarks concerning the surgical technique 62
2.6.4 Errors and complications 63
2.6.5 Real-life examples 64
2.6.6 Summary 64
2.7 Anastomotic insufficiency in the gastrointestinal tract as a frequent source of malpractice claims 65
2.7.1 Introduction 65
2.7.2 Fundamental concepts 65
2.7.3 Anastomotic leaks in the upper gastrointestinal tract 67
2.7.4 Errors and management of complications 68
2.7.5 Real-life example 69
2.7.6 Anastomotic leakage in the lower gastrointestinal tract – errors and risks 70
2.7.7 Examples of liability issues 71
2.7.8 Summary 73
2.8 Diagnostic and therapeutical errors in the treatment of acute abdomen 73
2.8.1 Introduction 73
2.8.2 Fundamentals 73
2.8.3 Malpractice claims and complications related to peritonitis and abdominal sepsis 76
2.8.3.1 Peritonitis with abdominal sepsis 76
2.8.4 Real-life examples 78
2.8.5 Ileus 80
2.8.6 Malpractice claims related to surgical ileus treatment 82
2.8.7 Real-life examples 82
2.8.8 Mesenteric ischemia 84
2.8.8.1 Diagnostic and therapeutic errors related to mesenteric ischemia 84
2.8.9 Real-life example 85
2.8.10 Summary 86
3 Retained surgical foreign bodies 107
3.1 Introduction 107
3.2 The issue of retained surgical foreign bodies 107
3.3 Risk management related to the prevention of RSFBs 109
3.4 Real-life examples 110
3.5 Summary 111
4 Quality management related to wrong-site surgery 115
4.1 Introduction 115
4.2 Statistical surveys 115
4.3 Root cause analysis 117
4.4 Risk management related to the prevention of WSPEs 119
4.5 Summary 122
5 Towards a preventive safety culture within the hospital 125
5.1 Introduction 125
5.2 Safety culture 125
5.3 Error management as part of quality management in the hospital 126
5.4 Error classification 128
5.5 The JCAHO patient safety event taxonomy 129
5.6 Reporting systems as tools to aid safety culture and risk management 130
5.6.1 CIRS as an aspect of risk management 137
5.7 Summary 139
6 Ethical aspects of an open safety culture: towards a new physician-patient relationship in 21st century medicine 143
Bibliography 155
Index 185