English summary: COMPLICATIONS RELATED TO CHOLECYSTECTOMIES IN 2005-2007: AN ANALYSIS OF CASES JUDGED BY THE PATIENT INSURANCE CENTRE IN FINLAND
Background Each year about 10 000 cholecystectomies are performed by numerous surgeons in various hospitals in Finland. It is a well established fact that a cholecystectomy carries a rather stable risk for complications, of which bile duct injuries leading to disability and even death are the most feared. The Patient Insurance Centre in Finland (PIC) provides financial compensation for patients who have suffered injury in connection with medical or surgical treatment. The PIC also plays a role in trying to prevent such complications by making the data of the claims available for independent analysis and for publication in order to inform healthcare workers. Our analysis looked at the claims concerning complications of cholecystectomies and the main aim of the study was to find out if there was a lesson to be learned.
Methods We analysed claims addressed to and judged by the PIC during the years 2005-2007. This material included decisions for (76) and against (67) compensation, which were compared with each other. We looked especially for the known complications of cholecystectomy and compared these to various parameters related to the patients, the doctors and the operation techniques used.
Results The study included 143 judgements of which 76 awarded compensation to the patient. The most common indication for the operation was uncomplicated cholelithiasis (78%). The cholecystectomies were begun laparoscopycally in 141 cases, with conversion to open surgery in 21 patients (14.7%). Perioperative cholangiography was performed in 11% of the operations. The overall range of different complications was wide, but the three most common (adding up to 66%) were bile duct injury, bleeding and bowel injury. Seven complications led to death and were related to late detection of bile duct injury and concomitant infection.
Conclusions The patients who received compensation suffered some kind of permanent disability in 14% of cases. The perioperative complication was overlooked in about half of the cholecystectomies, with fatal consequence in those patients who had a bile duct lesion. This might explain why so few perioperative cholangiographies and conversions to open cholecystectomy were performed. The level of complications related to laparoscopic cholecystectomy appears to have been stable for at least a decade although the risks of the procedure are now very well established. In order to lower the complication rates even further we seem to need new means of influencing the attitudes of surgeons and also maybe to take advantage of the modern teaching methods (simulators etc) now available.
