Fehler und Gefahren: Tonsillektomie und andere Standard-Eingriffe

Abstract

Septoplasty, tonsillectomy (with and without adenoidectomy) and cervical lymph node excision are amongst the most common 50 inpatient operations in Germany. Intracapsular tonsillectomies (i.e., tonsillotomies) are increasingly performed. The aim of this study was to evaluate alleged medical malpractice, technical traps and pitfalls associated with tonsillectomy (TE), adenoidectomy (AE), tonsillotomy (TT), septoplasty (SP) and cervical lymph node excision (LN).A questionnaire was sent to the Regional Medical Conciliation Boards, Medical Services of the Health Insurance Companies (MDK) and Regional Institutes of Forensic Medicine in Germany to collect anonymized cases of complications or medico legal implications following TE, TT, AE, LN and SP. The results were discussed in the light of the contemporary medical literature and published verdicts in Germany.The response rate of our survey was 55.9%. The Institutes of Forensic Medicine contributed 9 cases, 49 cases were submitted by the Regional Conciliation Boards and none by MDK. All forensic cases were associated with exsanguinations following tonsillectomy including 2 children (5 and 8 years of age) and 7 adults (aged 20-69 years). The fatal post-tonsillectomy hemorrhage (PTH) had occurred 8.7 days on average; 4 patients experienced the bleeding episode at home (day 5, 8, 9 and 17, respectively). Repeated episodes of bleeding requiring surgical intervention had occurred in 6 patients. 3 Conciliation Boards submitted expert opinions concerning cases TT (1), AE (4), LN (3), SP (16) and TE (25). Cases with lethal outcome were not registered. Only 3 of the 49 cases were assessed as surgical malpractice (6.1%) including lesion of the spinal accessory nerve, wrong indication for TE and dental lesion after insertion of the mouth gag. The review of the medico legal literature yielded 71 published verdicts after AE and TE (29), LN (28) and SP (14) of which 37 resulted in compensation of malpractice after LN (16; 57%), TE (11; 41%), SP (8; 57%) and AE (2; 100%). There were 16 cases of PTH amongst 27 trials after TE resulting either in death (5) or apallic syndrome (5). Bleeding complications had occurred on the day of surgery in only 2 patients. 16 trials were based on malpractice claims following SP encompassing lack of informed consent (6), anosmia (4), septal perforation (2), frontobasal injury (2) and dry nose (2). Trials based on LN were associated exclusively with a lesion of the spinal accessory nerve (28), including lack of informed consent in 19 cases. 49 cases (69%) were decided for the defendant, 22 (31%) were decided for the plaintiff with monetary compensation in 7 of 29 AE/TE-trials, 9 of 28 LN-trials and 6 of 14 SP-trials. Lack of informed consent was not registered for AE/TE but LN (11) and SP (2).Complicated cases following TE, TT, ATE, SP and LN are not systematically collected in Germany. It can be assumed, that not every complicated case is published in the medical literature or law journals and therefore not obtainable for scientific research. Alleged ...

Tonsillektomie: offizielle Zahlen und Trends in Deutschland

“…Bereits 2013 war auf die versorgungsmedizinische Größenordnung der TE unter Hinweis auf die Daten des Statistischen Bundesamts hingewiesen worden [36]. Im Jahr 2010 fanden sich 5 -289,1 m 2,9 % 4,5 % 5,4 % 9,4 % 11,2 % 11,4 % 9,0 % 9,1 % 8,0 % 7,8 % 7,5 % 6,8 % 6,2 % 5 -289,1 w 2,7 % 4,3 % 5,2 % 5,4 % 6,0 % 6,1 % 4,9 % 5,3 % 4,5 % 4,8 % 4,9 % 4,8 % 5,7 % 51,983 (2003) [11], Frankreich 50 000 Kinder [45], Großbritannien 78 000 [46] und 90 000 [47], und für die USA: 1 400 000 (1959) und 500 000 (1979) [48], 286 000 (1994) [49,50] sowie 287 000 bei Kindern (1996) [51] sowie 530 000 bei Kindern [52][53][54] sowie 250 000 [55].…”

Adenoide Vegetationen – Diagnostik und Therapie – die neue S2k-Leitlinie

“…Es gibt in Deutschland keinen nationalen Konsensus für die Indikation zur histologischen Untersuchung nach einer Adenotomie [ 58 ]. So zeigte zuletzt eine nichtrepräsentative Umfrage (unter 68 HNO-Abteilungen in Deutschland), dass 54 % der Befragten bei Kindern routinemäßig eine histologische Untersuchung zwar veranlassen, aber weniger als ein Drittel die Notwendigkeit hierfür als gegeben sieht [ 21 ].…”

Tonsillenchirurgie: Einfluss des Tonsillenspatels auf den Pharynxdurchmesser

“…Derzeit spricht viel dafür, dass der Ersatz der Tonsillektomie durch die Tonsillotomie bei selektiver Indikationsstellung nicht nachteilig für das Ergebnis bei deutlich geringerer postoperativer Morbidität ist [11]. Trotz dieses Vorteils dürfen die Berichte über tödlich verlaufende Blutungskomplikationen nicht ignoriert werden [9]. Ähnlich wie in den Fällen nach Tonsillektomie wurden bei der Autopsie Verletzungen von Ästen der A. carotis externa nachgewiesen [5,13].…”