Analysis of surgical errors in malpractice claims in Belgium.

The relative importance of the different factors that cause surgical error is unknown. Malpractice claim file analysis may help to identify leading causes of surgical errors and identify opportunities for prevention. We retrospectively reviewed 427 surgical malpractice claims from 3202 malpractice liability cases in which patients alleged error between 1996 and 2006. Surgeon-reviewer examined the litigation file and medical record to determine whether and injury attributable to surgical error had occurred and, if so, what factors contributed. Detailed descriptive information concerning etiology and outcome was recorded. The reviewer identified surgical errors that resulted in patient injury in the 427 studied claims. Sixty-three percent of these cases involved significant or major injury; 6% involved death. In most cases (48%), errors occurred in intra operative care; 15% in preoperative care; 37% in postoperative care. Nine percent of the cases had errors occurring during multiple phases of care; in 28%, more than one clinician played a contributory role. System factors contributed to error in 90% of cases. The leading system factors were inexperience/lack of technical competence (57%) and communication breakdown (42%). Cases with technical errors (57%) were more likely than those without technical errors (43%) to involve elective surgery (57% vs. 60%, Fisher's Exact Test < 0.001). There were no clear contributions to error from multiple personnel (26% vs. 31%, Fisher's Exact Test 0.28) and errors in multiple phases of care (73% vs. 68%, Fisher's Exact Test 0.28). In addition technical error cases were more likely than those without technical errors to have been caused by lack of clear lines (14% vs. 21%, Fisher's Exact Test 0.03), abnormal or different anatomy (6% vs. 2%, Fisher's Exact Test 0.04), interruption or distraction (14% vs. 4%, Fisher's Exact Test < 0.001). On the other hand, they were less likely to have been caused by judgment errors (47% vs. 59%, Fisher's Exact Test < 0.001). There were significant more problems caused by the numbers of personnel involved in university hospitals than in non-university hospitals. On the other hand, they were less likely to have been caused by failure of vigilance/memory (16% vs. 58% Fisher's Exact Test < 0.001), breakdown (19% vs. 50%, Fisher's Exact Test < 0.001), lack of supervision (2% vs. 34%, Fisher's Exact Test < 0.001) and lack of clear lines (1% vs. 22%, Fisher's Exact Test < 0.001) in university hospitals than in non-university hospitals. System factors play an important role in most surgical errors, including technical errors and some non technical errors. Malpractice claims analysis could encrypt the leading areas for intervening to reduce errors.