Patterns of malpractice claims and compensation after surgical procedures: a retrospective analysis of 8,901 claims from the Finnish patient insurance registry

Abstract

Background Invasive surgical procedures carry risk of harm to patients. In addition to avoidable harm, disparities between patient expectations and the outcome of a procedure may lead to patient injury claims. The follow-up of claims and compensation is an important entity for patient safety. The number of claims should be related to the surgical volume, so that a healthcare provider can benchmark with similar organizations and see if its trends are developing favourably or deteriorating. Our objective was to find out the claims and compensation rates due to surgery in an insurance-based system. Methods Data related to surgical claims and reference volume in the period 2011–2015 were collected from the claim register of the Finnish Patient Insurance Centre and benchmarking community register of Finnish operating departments. The data included age, gender, hospital, year of surgery, surgical code, and outcome of the claim. Results There were 8,901 claims related to the corresponding reference group of 1,470,435 surgical procedures. The claims rate was 0.61% and compensation rate was 0.22%. Trends for claims and compensation rates decreased over the study period. In high volume procedures, a low compensation rate was detected for excision of tonsils and adenoids, Caesarean section and extracapsular cataract operations using the phacoemulsification technique. A high compensation rate was detected for primary prosthetic replacement of the hip and knee joints and decompression of spinal cord and nerve roots. Unreasonable injury (death or permanent deterioration of health) was compensated in 2.4 per 100,000 procedures. Conclusions Register data research in a no-fault patient insurance system revealed a claims rate of 6 per 1,000 procedures and compensation rate of 2 per 1,000 procedures. A decreasing trend in both rates over the study period was detected. Different surgical procedures exhibit varying claims and compensation rates.

Prevalence of malpractice claims after arthroscopic shoulder surgery: analysis of 69,097 procedures from a national registry in Norway

“…Similar to our findings, they reported an overall claim rate of 6 per 1000 procedures (0.6%) but denoted that “different surgical procedures exhibit varying claims”. Similar to other studies, we found an acceptance rate of compensation claims at nearly 40% [ 4 , 5 , 7 , 11 ].…”

“…However, these procedures are open surgeries with high expectations and wider complications which may partially explain the difference found in our material. In a retrospective study from Finland, 8 901 compensation claims after various surgical procedures were analyzed [ 11 ]. Similar to our findings, they reported an overall claim rate of 6 per 1000 procedures (0.6%) but denoted that “different surgical procedures exhibit varying claims”.…”

Obstetric claims in Finland 2012–2022—A nationwide patient insurance registry study

“…In 2022, the proportion of cesarean deliveries in Finland was 19.6% and has shown a continuous increase since the late 2010s 13 . However, cesarean deliveries have lower compensation rates compared to other surgical procedures in Finland 16 . In addition, changes in maternal characteristics, 13 such as increased maternal obesity and age, 17 may be associated with the incidence of maternal and neonatal injuries 18,19 and thus with increased claims.…”

“…13 However, cesarean deliveries have lower compensation rates compared to other surgical procedures in Finland. 16 In addition, changes in maternal characteristics, 13 such as increased maternal obesity and age, 17 may be associated with the incidence of maternal and neonatal injuries 18 , 19 and thus with increased claims. Although there was no increase in the rate of compensated claims in this study, the rate was higher (19.5% vs 26.4%) than in a study reporting on obstetric claims in Finland from 1987 to 1995.…”

Upper gastrointestinal endoscopy procedure volume trends, perioperative mortality, and malpractice claims: Population-based analysis

“…The PIC claim process involves expert medical professionals who evaluate the claims and their compensability. The criteria for compensation have been described in more detail in previous studies 33 34 35 . All postoperative AEs reported in the claims were collected and classified by Clavien-Dindo Classification.…”