Health-care related injuries and adverse events (AE) are harmful and incur unnecessary suffering for the patient, and are an additional cost to the patient, the health-care system and the community. Complications due to failure in adhering to accepted practice, or AE due to substandard care are avoidable and should be prevented. Examination of the causes and outcomes of AE after health-care intervention may contribute to the development of prevention strategies, and knowledge about medico-legal and insurance claims (IC) is important for risk management and safe clinical practice.
Special types of iatrogenic injuries include those affecting the vascular system and those associated with open or endovascular vascular surgery, and iatrogenic vascular injuries may cause severe morbidity and even death.1 Rare complications are difficult to study prospectively and retrospective medical record reviews may be subject to underreporting.2 Insurance claims for malpractice and medical negligence are potentially useful sources of information on complications after surgery and, from them, clinical lessons can be learned.3
In cases of malpractice and complications associated with substandard care, patients in Sweden are entitled to compensation from the County Councils’ Mutual Insurance Company under the Patients Injury Act (Patientskadelagen 1996:799). The Swedish Medical Injury Insurance (SMII) is responsible for the entire investigation and collates all medical documents and case records. All claims are analysed by an independent expert group. If the expert opinions advise the standard of care is inferior to that expected, or there was failure to adhere to accepted practice, and which resulted in the patient suffering harm, economic compensation is paid. There are more than 9000 claims annually, and 45% receive economic compensation.4
The Swedish Vascular Registry (Swedvasc) was started in 1987. By January 1994, all 42 hospitals performing vascular surgery in Sweden participated. Swedvasc was validated externally and compared with the In-Patient Registry, and is used for reimbursement: the validation indicates the general report rate is higher than 90%.5
The primary aims of this study were to estimate the incidence and causes of insurance claims for medical negligence in relation to vascular surgery in Sweden. The secondary aim was to validate the registration of SMII cases of vascular surgery in Swedvasc.