title: Surgery of the hallux valgus in an ambulatory setting: a liability risk?
abstract: BACKGROUND
  The primary objective of the study is to make an inventory of malpractice in hallux valgus surgery in an ambulatory setting and to identify the patient characteristics for a higher risk of malpractice. The secondary objective is creating a methodology for analyzing the medicolegal aspects of a surgery in day case comparing with hospitalization.
  
  
  METHODS
  The database of the Branchet insurance company was used. A total of 11,000 claims for a period of 11 years (2002-2013) have been investigated. The files of the patients with hallux valgus surgery were isolated from the insurer's database using CCAM codes. The medical director, a medical officer, the legal expert and finally the judge had already analyzed all these cases. The authors reviewed the various documents with a specific questionnaire.
  
  
  RESULTS
  We identified 14 cases of claims in relation with hallux valgus 1-day surgery among a total of 138 claims for hallux valgus including all techniques (10%). All patients were female. The mean age was 42.6 years (19-64) in ambulatory patients (AG group) in comparison with 49.5 years (19-73) in hospitalized patients (HG group). Percutaneous techniques were significantly more represented in the AG group (p = 0.002) and scarfs osteotomies in the HG group (p = 0.004). The use of tourniquet seemed to be lower in the AG group, but it was a not significant trend (p = 0.085). In term of anesthesia procedures, no significant differences were seen between the two groups. The comparison of the complications common to both groups showed no significant difference except for insufficient results which were more frequent in the AG group (p = 0.026). The rate of insufficient informed consent seemed to be higher in the AG group, but it was a not significant trend (p = 0.084).
  
  
  CONCLUSIONS
  No specific data regarding claims in relation with hallux valgus 1-day surgery are available to our knowledge in the literature. We did not identify in our study specific complications related to ambulatory procedures except for insufficient results. Hallux valgus 1-day surgery does not seem to expose surgeons to higher medicolegal problems than classical hospitalization. Nevertheless, a specific consent form for ambulatory patients is required to limit claims regarding information.
authors.affiliation: Orthopedic and Trauma Surgery Department, Central Hospital, University Hospital of Nancy, 29 Av.de Lattre de Tassigny, 54035, Nancy Cedex, France. l.galois@chru-nancy.fr.
authors.forename: L
authors.identifier: http://orcid.org/0000-0002-0457-4189
authors.initials: L
authors.lastname: Galois
authors.affiliation: Orthopedic and Trauma Surgery Department, University Hospital of Mons-Hainaut, Av. Baudouin de Constantinople, 7000, Mons, Belgium.
authors.forename: J-M
authors.initials: JM
authors.lastname: Serwier
authors.affiliation: Orthopedic and Trauma Surgery Department, University Hospital of Mons-Hainaut, Av. Baudouin de Constantinople, 7000, Mons, Belgium.
authors.forename: A D
authors.initials: AD
authors.lastname: Arashvand
mesh_terms: D000328:Adult; D000368:Aged; D000556:Ambulatory Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D005602:France; D006215:Hallux Valgus / Q000000981:diagnostic imaging / Q000601:surgery*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D007344:Insurance Claim Reporting; D016365:Liability, Legal; D008875:Middle Aged; D010027:Osteotomy / Q000009:adverse effects / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology / Q000503:physiopathology; D011379:Prognosis; D012008:Recurrence; D012189:Retrospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome; D055815:Young Adult