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