title: [Epidemiology of the medico-legal risk associated with the practice of ambulatory surgery in France: a study based on insurance data].
abstract: The medico-legal risk specifically associated with the practice of ambulatory surgery is still not well studied. SHAM insurances are the biggest French provider of medical liability insurances. The study of the insurance claims provided by this insurer is therefore a relevant source of data on the complications related to ambulatory surgery.
  
  
  OBJECTIVE
  The aim of this study was to compare the claim rate related to ambulatory surgery with non-ambulatory surgery.
  
  
  METHODS
  We did a retrospective study on insurance claims provided by SHAM insurances between 2007 and 2011 to compare the claim rate related to ambulatory surgery with non-ambulatory surgery.
  
  
  METHODS
  We searched the files in the SHAM database, and then analyzed them.
  
  
  RESULTS
  On the study period, out of a total of 29565 registered claims, 467 (1.6%) originated from ambulatory surgery. On the total of 29,098 registered claims for non-ambulatory surgery, 2151 (7.4%) led to a condemnation whereas the rate was 7% (33 out of 467 claims) for ambulatory surgery. The condemnations linked to ambulatory surgery amounted to 1.5% of the total (33 out of 2184), for a cost of 1.7 M€ (versus 400,3 M€ for non-ambulatory surgery). The average cost of a compensation is therefore 50,500 € for ambulatory surgery and 186,000 € for non-ambulatory surgery. The medical specialties concerned are primarily ophthalmology, abdominal and orthopedics surgery. The main identified causes were medical errors (n=16) and nosocomial infections (n=13).
  
  
  CONCLUSIONS
  The claim rate in ambulatory surgery is proportionally less frequent with compensations three times less and were related to the most frequent type of surgery done in ambulatory settings. These data should help strengthen quality approach in ambulatory surgery.
authors: Service d'anesthésie réanimation, centre hospitalier Princesse Grace, 1, avenue Pasteur, 98010 Monaco, Monaco. Electronic address: alexandretheissen@hotmail.com.
authors: A
authors: A
authors: Theissen
authors: SHAM, service gestion des risques, 18, rue Édouard-Rochet, 69372 Lyon cedex 08, France.
authors: F
authors: F
authors: Fuz
authors: Service d'anesthésie réanimation, centre hospitalier Princesse Grace, 1, avenue Pasteur, 98010 Monaco, Monaco.
authors: J
authors: J
authors: Catineau
authors: Service d'anesthésie réanimation, centre hospitalier Princesse Grace, 1, avenue Pasteur, 98010 Monaco, Monaco.
authors: W
authors: W
authors: Sultan
authors: Unité de chirurgie ambulatoire, département d'anesthésie réanimation, hôpital Saint-Antoine, 184, rue du Faubourg Saint-Antoine, 75571 Paris cedex12, France.
authors: M
authors: M
authors: Beaussier
authors: Service d'anesthésie réanimation, hôpital de l'Archet, CHU de Nice, 06202 Nice cedex 3, France.
authors: M
authors: M
authors: Carles
authors: Service d'anesthésie réanimation, hôpital de l'Archet, CHU de Nice, 06202 Nice cedex 3, France.
authors: M
authors: M
authors: Raucoules-Aimé
authors: Service d'anesthésie et chirurgie ambulatoire, centre hospitalier Princesse Grace, 1, avenue Pasteur, 98010 Monaco, Monaco.
authors: P
authors: P
authors: Niccolai
mesh_terms: D000556:Ambulatory Surgical Procedures / Q000191:economics / Q000331:legislation & jurisprudence* / Q000639:trends; D016208:Databases, Factual; D005602:France / Q000453:epidemiology; D006801:Humans; D007345:Insurance Claim Review; D007351:Insurance, Liability / Q000191:economics / Q000706:statistics & numerical data* / Q000639:trends; D016365:Liability, Legal; D019300:Medical Errors / Q000331:legislation & jurisprudence; D012189:Retrospective Studies; D012306:Risk
keywords: Ambulatory surgery; Chirurgie ambulatoire; Claims; Compensation; Complication; Indemnisation; Personal injury; Préjudice; Responsabilité; Responsibility; Sinistralité