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      Compensation after Distal Radial Fractures. A Review of 800 claims to the Norwegian System of Patient Injury Compensation 2000-2013

      , , , ,
      The Open Orthopaedics Journal
      Bentham Science Publishers Ltd.

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          Abstract

          Background:

          Distal radial fracture is the most common fracture in humans.

          Objective:

          The purpose of the present study was to assess the compensation claims filed to The Norwegian System of Patient Injury Compensation (NPE) after the treatment of distal radial fractures from 2000 through June 2013.

          Methods:

          Data received by the NPE were collected and categorized into groups depending on acceptance or rejection of the claim. In both groups, the cases were systemized according to the type of primary treatment, either operative or conservative. Patient demographics were recorded, along with the patient´s reason(s) for the compensation claim, registered complications and the NPE´s reason(s) for the acceptance or rejection of the claim.

          Results:

          Eight hundred compensation claims were received. Forty-three percent of claims were granted, of which 71% had been treated conservatively and 29% had received surgical treatment. Pain was the most common complaint. There were a higher number of upheld claims in hospitals with a population area of less than 100,000 people as opposed to larger hospitals.

          Conclusion:

          The most common cause for compensation was delayed intervention when reduction was lost after conservative treatment. Most of the compensations after surgery were due to wrong technique. Only 30 patients with upheld claims received volar plating. Pain is not a valid reason for compensation on its own. There is a higher risk of ending up with a complication that leads to compensation if the patient is treated in a small hospital.

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          Most cited references15

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          Hospital volume and surgical mortality in the United States.

          Although numerous studies suggest that there is an inverse relation between hospital volume of surgical procedures and surgical mortality, the relative importance of hospital volume in various surgical procedures is disputed. Using information from the national Medicare claims data base and the Nationwide Inpatient Sample, we examined the mortality associated with six different types of cardiovascular procedures and eight types of major cancer resections between 1994 and 1999 (total number of procedures, 2.5 million). Regression techniques were used to describe relations between hospital volume (total number of procedures performed per year) and mortality (in-hospital or within 30 days), with adjustment for characteristics of the patients. Mortality decreased as volume increased for all 14 types of procedures, but the relative importance of volume varied markedly according to the type of procedure. Absolute differences in adjusted mortality rates between very-low-volume hospitals and very-high-volume hospitals ranged from over 12 percent (for pancreatic resection, 16.3 percent vs. 3.8 percent) to only 0.2 percent (for carotid endarterectomy, 1.7 percent vs. 1.5 percent). The absolute differences in adjusted mortality rates between very-low-volume hospitals and very-high-volume hospitals were greater than 5 percent for esophagectomy and pneumonectomy, 2 to 5 percent for gastrectomy, cystectomy, repair of a nonruptured abdominal aneurysm, and replacement of an aortic or mitral valve, and less than 2 percent for coronary-artery bypass grafting, lower-extremity bypass, colectomy, lobectomy, and nephrectomy. In the absence of other information about the quality of surgery at the hospitals near them, Medicare patients undergoing selected cardiovascular or cancer procedures can significantly reduce their risk of operative death by selecting a high-volume hospital.
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            Should operations be regionalized? The empirical relation between surgical volume and mortality.

            This study examines mortality rates for 12 surgical procedures of varying complexity in 1498 hospitals to determine whether there is a relation between a hospital's surgical volume and its surgical mortality. The mortality of open-heart surgery, vascular surgery, transurethral resection of the prostate, and coronary bypass decreased with increasing number of operations. Hospitals in which 200 or more of these operations were done annually had death rates, adjusted for case mix, 25 to 41 per cent lower than hospitals with lower volumes. For other procedures, the mortality curve flattened at lower volumes. For example, hospitals doing 50 to 100 total hip replacements attained a mortality rate for this procedure almost as low as that of hospitals doing 200 or more. Some procedures, such as cholecystectomy, showed no relation between volume and mortality. The results may reflect the effect of volume or experience on mortality, or referrals to institutions with better outcomes, as well as a number of other factors, such as patient selection. Regardless of the explanation, these data support the value of regionalization for certain operations.
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              Surgeon volume and operative mortality in the United States.

              Although the relation between hospital volume and surgical mortality is well established, for most procedures, the relative importance of the experience of the operating surgeon is uncertain. Using information from the national Medicare claims data base for 1998 through 1999, we examined mortality among all 474,108 patients who underwent one of eight cardiovascular procedures or cancer resections. Using nested regression models, we examined the relations between operative mortality and surgeon volume and hospital volume (each in terms of total procedures performed per year), with adjustment for characteristics of the patients and other characteristics of the providers. Surgeon volume was inversely related to operative mortality for all eight procedures (P=0.003 for lung resection, P<0.001 for all other procedures). The adjusted odds ratio for operative death (for patients with a low-volume surgeon vs. those with a high-volume surgeon) varied widely according to the procedure--from 1.24 for lung resection to 3.61 for pancreatic resection. Surgeon volume accounted for a large proportion of the apparent effect of the hospital volume, to an extent that varied according to the procedure: it accounted for 100 percent of the effect for aortic-valve replacement, 57 percent for elective repair of an abdominal aortic aneurysm, 55 percent for pancreatic resection, 49 percent for coronary-artery bypass grafting, 46 percent for esophagectomy, 39 percent for cystectomy, and 24 percent for lung resection. For most procedures, the mortality rate was higher among patients of low-volume surgeons than among those of high-volume surgeons, regardless of the surgical volume of the hospital in which they practiced. For many procedures, the observed associations between hospital volume and operative mortality are largely mediated by surgeon volume. Patients can often improve their chances of survival substantially, even at high-volume hospitals, by selecting surgeons who perform the operations frequently. Copyright 2003 Massachusetts Medical Society
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                Author and article information

                Journal
                The Open Orthopaedics Journal
                TOORTHJ
                Bentham Science Publishers Ltd.
                1874-3250
                October 30 2018
                October 30 2018
                : 12
                : 1
                : 419-426
                Article
                10.2174/1874325001812010419
                53d518e9-89a4-4eaa-90fb-3890059a6e2e
                © 2018

                https://creativecommons.org/licenses/by/4.0/legalcode

                History

                Medicine,Chemistry,Life sciences
                Medicine, Chemistry, Life sciences

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