title: Fatal surgical or procedure-related complications: a Finnish registry-based study.
abstract: BACKGROUND
  In Finland, all healthcare personnel must be insured against causing patient injury. The Patient Insurance Centre (PIC) pays compensation in all cases of malpractice and in some cases of infection or other surgical complications. This study aimed to analyze all complaints relating to fatal surgical or other procedure-related errors in Finland during 2006-2010.
  
  
  METHODS
  In total, 126 patients fulfilled the inclusion criteria. Details of patient care and decisions made by the PIC were reviewed, and the total national number of surgical procedures for the study period was obtained from the National Hospital Discharge Registry.
  
  
  RESULTS
  Of the 94 patients who underwent surgery, most fatal surgical complications involved orthopedic or gastrointestinal surgery. Non-surgical procedures with fatal complications included deliveries (N = 10), upper gastrointestinal endoscopy or nasogastric tube insertion (N = 8), suprapubic catheter insertion (N = 4), lower intestinal endoscopy (N = 5), coronary angiogram (N = 1), pacemaker fitting (N = 1), percutaneous drainage of a hepatic abscess (N = 1), and chest tube insertion (N = 2). In 42 (33.3 %) cases, patient injury resulted from errors made during the procedure, including 24 technical errors and 15 errors of judgment. There were 19 (15.2 %) cases of inappropriate pre-operative assessment, 28 (22.4 %) errors made in postoperative follow-up, 23 (18.4 %) cases of fatal infection, and 11 (8.8 %) fatal complications not linked to treatment errors.
  
  
  CONCLUSIONS
  Fatal surgical and procedure-related complications are rare in Finland. Complications are usually the result of errors of judgment, technical errors, and infections.
authors.affiliation: Departments of Surgery and Anesthesiology, North Karelia Central Hospital, Tikkamaentie 16, 80201, Joensuu, Finland, tapio.hakala@pkssk.fi.
authors.forename: Tapio
authors.initials: T
authors.lastname: Hakala
authors.forename: Jaana
authors.initials: J
authors.lastname: Vironen
authors.forename: Sari
authors.initials: S
authors.lastname: Karlsson
authors.forename: Jarkko
authors.initials: J
authors.lastname: Pajarinen
authors.forename: Eero
authors.initials: E
authors.lastname: Hirvensalo
authors.forename: Hannu
authors.initials: H
authors.lastname: Paajanen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002404:Catheterization / Q000401:mortality*; D004322:Drainage / Q000401:mortality*; D004724:Endoscopy / Q000401:mortality*; D005260:Female; D005387:Finland / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007431:Intraoperative Complications / Q000401:mortality; D007440:Intubation / Q000401:mortality*; D008297:Male; D019300:Medical Errors / Q000401:mortality* / Q000706:statistics & numerical data; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality; D012042:Registries; D013514:Surgical Procedures, Operative / Q000401:mortality*