[Complaints in orthopedics reported to the Norwegian Patient Compensation System 1993-99].
BACKGROUND
The Norwegian Patient Compensation System (NPCS) was started up in January 1988. By the end of 1999, a total of 15,552 complaints had been received. This paper reviews the outcome of the complaint procedures in the field of orthopaedics.


METHODS
From 1993 to 1999, the NPCS assessed a total of 8,520 complaints of which 4,041 (47%) were in orthopaedics. On the basis of abstracts of these cases, we retrieved more detailed information.


RESULTS
Over the period, 39% of orthopaedic complaints resulted in compensation, with a decline from 45% in 1993 to 32% in 1999. 328 orthopaedic patients were awarded compensation on the basis of infection; they constituted 8% of all compensated claims and 21% of all compensated orthopaedic claims. These ratios remained fairly constant throughout the period. Compensation was given to 291 patients with loosening of prostheses following use of Boneloc cement; these cases represented 7% of all orthopaedics claims and 18% of all compensated claims. Complaints were most numerous in 1996 and 1997; this reflected the use of this cement in the early 1990s. Rejected complaints were appealed with increasing frequency; in 1999, 46% of all NPCS cases were appealed, 33% of all orthopaedic cases. Rejections overruled following appeal were within a range of 16% (1994) and 11% (1995). When initial rejections overruled on appeal are included, the total compensation-to-claims ratio increases from 39% to 41%.


CONCLUSIONS
The high number of complaints in orthopaedics probably reflects the high frequency of musculoskeletal disorders in the population. It is to be hoped that evaluation of treatment injuries will result in a higher quality of patient treatment.
Bjerkreim
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Oslo ortopediske universitetsklinikk Trondheimsveien 132 0570 Oslo. ingjald.bjerkreim@rikshospitalet.no
Steen
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D016208:Databases, Factual; D006801:Humans; D007345:Insurance Claim Review / Q000331:legislation & jurisprudence; D019300:Medical Errors / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data*; D009664:Norway / Q000453:epidemiology; D009985:Orthopedics / Q000592:standards / Q000706:statistics & numerical data*; D011475:Prosthesis Failure; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000209:etiology