What can we learn from patient claims? A retrospective analysis of incidence and patterns of adverse events after orthopaedic procedures in Sweden

In this retrospective review data from two Swedish national databases during a 4-year period were analyzed. We used the "County Councils' Mutual Insurance Company", a national no-fault insurance system for patient claims, and the "National Patient Register at the National Board of Health and Welfare".A total of 6,029 patient claims filed after orthopaedic surgery were assessed during the study period. Of those, 3,336 (55%) were determined to be adverse events, which received financial compensation. Hospital-acquired infections and sepsis were the most common causes of adverse events (n = 741; 22%). The surgical procedure that caused the highest rate of adverse events was "decompression of spinal cord and nerve roots" (code ABC**), with 168 adverse events of 17,507 hospitals discharges (1%). One in five (36 of 168; 21.4%) injured patient was seriously disabled or died.We conclude that patients undergoing spinal surgery run the highest risk of being severely injured and that these patients also experienced a high degree of serious disability. The most common adverse event was related to hospital acquired infections. Claims data obtained in a no-fault system have a high potential for identifying adverse events and learning from them.Adverse events in connection with medical care are common [1-4] and, based on medical record reviews, several studies have shown that surgical specialities contribute a large share of adverse events [2,3,5]. A Swedish study estimated the number of preventable adverse events as high as 8.6%. Six percent of these adverse events were serious, contributed to death or permanent disability. The surgical disciplines accounted for approximately 62% of the adverse events [6].Orthopaedic adverse events have been studied in several investigations in recent years [7-11]. Screening for adverse events in medical and nursing records of 395 orthopaedic patients revealed that 16% of the patients experienced an adverse event [10]. Another study found a frequ