BACKGROUND

From 1995 the cost of litigation to the National Health Service (NHS) from surgical procedures has been over 1.3 billion GBP. Spinal patients can present diagnostic challenges and the consequences of delayed diagnosis and surgical complications can be devastating. As a consequence these patients represent a high risk when surgeons seek to indemnify themselves.

We therefore, aim to highlight the litigation patterns for these injuries within the United Kingdom.

Deep joint infection is one of the most dreaded complications of total joint arthroplasty, and urinary tract infections (UTI) are generally believed to be a source for haematogenous seeding of the prosthetic joint. Although patients are often screened for UTI there appears to be minimal evidence on the management of asymptomatic bacteriuria, or for those patients who perform intermittent self-catheterisation prior to joint arthroplasty. This study aims to address this.

We performed an online and postal survey of the British Association for the Surgery of the Knee membership to provide a consensus from a body of professionals. Of the respondents 75% performed 50 or more joint arthroplasty surgery over a 12 month period. For all surgeons, 71.4% provided antibiotic cover for the insertion and withdrawal of urinary catheters. However, only 19% were aware of National guidelines, compared to 76.2% for local guidelines which were more likely to be followed. Two thirds of surgeons would treat asymptomatic bacteriuria prior to surgery, yet 70% of these surgeons were unable to cite evidence for this decision. Similarly, the management of patients requiring intermittent self-catherisation produced a heterogenous response.

Our study suggests there is a lack of consensus and/or awareness amongst specialist knee surgeons for the management of asymptomatic urinary bacteriuria in patients prior to knee surgery. We believe a minimum standard of care be defined by the society to protect both patient and surgeon.

Background

Surgical patients have cost the NHS 1.3 billion GBP from 1995. Spinal pathologies can present diagnostic challenges, and the consequences of delayed diagnosis or surgical complications can be devastating and so creating high indemnity costs.

We aim to highlight the spinal associated litigation patterns within the United Kingdom.

Background: Over 70,000 hip replacements were performed in England and Wales in 2006/7 during which all litigation claims cost the National Health Service (NHS) over £600 million. Joint arthroplasty surgeons are twice as likely to be subject to litigation claims compared to other physicians. The complications associated with primary hip arthroplasty (HA) are well documented, however those instigating litigation in the UK are not known. In this study, the trends in litigation over the past 5 years were assessed to indentify the instigating factors and their associated success to highlight areas for further improvement in patient information and surgical management.

Methods: Data from the NHS Litigation Authority on claims following HA unrelated to trauma between 2002 and 2007 were obtained and analysed.

Results: 352 claims were made, 271 (77%) were settled of which 109 (40.1%) resulted in a successful claim. The total cost to the NHS was £8,558,000. The number of claims has increased from 54 in 2002 to 83 in 2007, while the rate of successful claims decreased from 46.7% to 12.9%. The three most common instigating factors were nerve injury (19.6%), Operator Error (14.2%) and ongoing pain (13.6%). The factors with greatest successful claims were Non-operative site injuries (70%), Operator Error (66%), Fracture (52.4%).

Conclusion: Litigation claims following Hip Arthroplasty are increasing, although there rate of success is decreasing. Non-operative site injuries, operator error and fractures are predictors of a successful claim. However, failure to consent adequately, adhere to policies and standard practice can result in a successful claim. Protecting patients intra-operatively and maintaining high technical expertise while implementing policies and informed consent decreases the litigation burden to the NHS

Introduction: The aim of this study was to assess the practice of obtaining informed consent for Total Hip Replacement Surgery in the United Kingdom.

Methods and results: 1571 consultant members of the BOA were surveyed by postal questionnaire regarding their practice towards obtaining informed consent for total hip replacement surgery. 524 (33.3%) replies were received. 368 (23.4%) of the 524 consultants who replied still performed total hip replacement surgery. In obtaining informed consent for hip replacement surgery consultants warned of the following complications: Infection 99.7%, Dislocation 98.9%, Leg length discrepancy 75.2%, Aseptic loosening 85.8%, neurovascular damage 61.9%, Wear 63.2%, DVT 96.0%, PE 89.0% and Mortality 71.6%. Consent was routinely obtained by Senior House Officers in 38.7%, by Pre-Registration House Officer in 3.8% and by specialist nurses in 5.4% of cases. Patient information leaflets were provided by 72.0% of consultants for Hip Replacement.

Discussion: We recommend national guidelines relating to obtaining consent for hip replacement should be published by the British Hip Society. This should be incorporated into their best practice documents regarding Hip replacement Surgery. Consent should also be obtained by a suitably experienced practitioner.

Purpose: The aim of this survey was to assess the practice of obtaining informed consent for Total Knee Replacement Surgery in the United Kingdom.

Method: A postal questionnaire was distributed to consultant members of the British Orthopaedic Association. They were questioned regarding their practice for obtaining informed consent for Total Knee Replacement Surgery.

Results: Of the 1571 consultant members contacted 34% (526) replied. From these 76% (400) performed total knee replacements. Informed consent was obtained in a pre-operative assessment clinic in 64%, on admission in 32.5% and during the first clinic visit in 3.5% of cases. Consent was routinely obtained by Consultants in 76%, Senior House Officers in 38%, Pre-Registration House Officers in 4% and Specialist Nurses in 5% of cases. Consultants warned of the following complications: Infection 99.2%, Stiffness 70.5%, Aseptic loosening 81.6%, neurovascular damage 56.9%, DVT 96.5%, PE 88.5%, Wear 61.2% and Mortality 67.4%. Patient information leaflets were provided by 71.5% of consultants for Total Knee Replacement.

Conclusions: This survey has identified inconsistencies in the complications described to patients. Junior practitioners are continuing to obtain informed consent. Informed consent should be obtained by a suitably experienced practitioner. Patient information leaflets should be provided to patients at the time of listing. We recommend national guidelines relating to obtaining consent for Total Knee Replacement should be published by the BASK. These could be incorporated into their best practice document regarding Total Knee Replacement Surgery.