Varicose vein surgery: a few medicolegal considerations Jon Ghosh SpR General / Vascular Surgery.

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Presentation transcript:

Varicose vein surgery: a few medicolegal considerations Jon Ghosh SpR General / Vascular Surgery

Friedrich Trendelenburg

Superficial Venous Surgery operations / year At 10 years (REACTIV study: Campbell 2003) –77% symptom free –Only 30% varicosity free –34% patients unsatisfied legal actions / year

Varicose vein litigation Total number of reported CNST claims by specialty from 1995 General / Vascular surgery claims settled by MDU

Varicose vein litigation Total number of reported CNST claims by specialty from 1995 General / Vascular surgery claims settled by MDU £5.5 million

Claim v complications rates %

%

Inappropriate surgery/ expectation of surgery * %

Reasons for legal action %

Grade of primary surgeon - all claims

Nerve Injury 30% claims Cutaneous C Peroneal Sural Saphenous

Nerve Injury 30% claims Cutaneous C Peroneal Sural Saphenous £15,000-90,000 n/a

Nerve Injury 30% claims Cutaneous C Peroneal Sural Saphenous £15,000-90,000 n/a

Major vascular injury Femoral vein most common Indefensible: £ damages

Major vascular injury Femoral vein most common Indefensible: £ damages

Major vascular injury Femoral vein most common Indefensible: £ damages DVT/PE –Indefensible: failure to provide prophylaxis in high risk pt. upto £550,000 damages

Observations Senior surgeons Patient selection Avoid hasty pre-op assessment Counseling (esp. after Chester v Ashfar) –Recurrences –Wound problems –Nerve injury risks Impact of endovascular technologies awaited

Observations Senior surgeons Patient selection Avoid hasty pre-op assessment Counseling (esp. after Chester v Ashfar) –Recurrences –Wound problems –Nerve injury risks Impact of endovascular technologies awaited

Observations Senior surgeons Patient selection Avoid hasty pre-op assessment Counseling (esp. after Chester v Ashfar) –Recurrences –Wound problems –Nerve injury risks Impact of endovascular technologies awaited

Observations Senior surgeons Patient selection Avoid hasty pre-op assessment Counseling (esp. after Chester v Ashfar) –Recurrences –Wound problems –Nerve injury risks Impact of endovascular technologies awaited

Complications % of all operations