Disability and litigation from urinary tract injuries at benign gynecologic surgery in Canada
Disability and litigation from urinary tract injuries at benign gynecologic surgery in Canada
复制标题
DOI：
10.1097/01.aog.0000144127.78481.8c
复制
发表时间：
2005-01-01
影响因子：
7.2
通讯作者：
Baskett, TF
中科院分区：
文献类型：
--
作者：
Gilmour, DT;Baskett, TF
目的：估计加拿大尿路损伤的患病率和良性妇科手术损伤引起诉讼的相对风险，并分析部分诉讼案例，确定预测医疗和法律结果的独立风险因素。方法：根据国家出院摘要和国家医师医疗事故数据库确定尿路损伤的患病率和损伤诉讼的相对风险。对部分诉讼案件进行多元逻辑回归。结果：良性妇科手术中尿路损伤的发生率较低（0.33%）。如果患者遭受尿路损伤，则诉讼的相对风险较高（相对风险 91，95% 置信区间 [CI] 55-158）。因异常子宫出血而进行子宫切除术造成尿路损伤后，患者出现严重残疾的可能性较高（比值比 [OR] 6.16，95% CI 1.13-39.01，P = .04），但永久性残疾的可能性较低（OR 0.23，95% CI 0.05-0.96，P = .05）。与其他类型的尿路损伤相比，输尿管梗阻后更容易出现永久性残疾（OR 4.54，95% CI 1.55-14.88，P = .008）。只有 18% 的损伤是在术中发现的。与其他类型的损伤相比，急性膀胱损伤在术中更容易被识别（OR 14.98，95% CI 3.89-57.74，P < .001）。术中未发现输尿管梗阻或尿路瘘。结论：尿路损伤是良性妇科手术的一种罕见但重要的并发症。此类伤害与相对较高的诉讼风险相关。 （Obstet Gynecol 2005；105:109-14。(C) 2005 年，美国妇产科医师学会。）。
OBJECTIVES: To estimate the prevalence of urinary tract injury and the relative risk of litigation from an injury for benign gynecologic surgery in Canada and to analyze a subset of cases of litigation, determining independent risk factors that predicted medical and legal outcomes.METHODS: The prevalence of urinary tract injury and the relative risks of litigation from an injury were determined from the national hospital discharge abstract and the national physician malpractice databases. Multiple logistic regression was performed on a subset of litigation cases.RESULTS: The prevalence of urinary tract injury at benign gynecologic surgery was low (0.33%). If a patient sustained a urinary tract injury, there was a high relative risk of litigation (relative risk 91, 95% confidence interval [CI] 55-158). Patients had a higher chance of major disability after urinary tract injury from hysterectomy for abnormal uterine bleeding (odds ratio [OR] 6.16, 95% CI 1.13-39.01, P = .04), but a lower chance of this being a permanent disability (OR 0.23,95% CI 0.05-0.96, P = .05). Permanent disability was more likely after an obstructed ureter compared with other types of urinary tract injuries (OR 4.54, 95% CI 1.55-14.88, P = .008). Only 18% of the injuries were recognized intraoperatively. An acute bladder injury was more likely to be recognized intraoperatively than other types of injury (OR 14.98,95% CI 3.89-57.74, P < .001). No obstructed ureters or urinary tract fistulae were recognized intraoperatively.CONCLUSION: Urinary tract injuries are an uncommon but significant complication from benign gynecologic surgery. Such injuries are associated a high relative risk of litigation. (Obstet Gynecol 2005;105:109-14. (C) 2005 by The American College of Obstetricians and Gynecologists.).