European Journal of Cardio-Thoracic Surgery, Vol 5, 57-60, Copyright © 1991 by European Association for Cardio-thoracic Surgery
Risk control and prevention of spinal cord damage due to surgery of thoracoabdominal aneurysms: medicolegal aspects
B de Mol, R Hamerlijnck, FE Vermeulen and R de Geest
Surgery of thoracoabdominal aneurysms is accompanied by many complications
of which spinal cord damage is the most serious. Such a complication tends
to be the subject of litigation and medicolegal assessment. This report
presents a risk control concept focussed on the reduction of spinal cord
damage after surgery for a thoracoabdominal aneurysm. This concept may
provide a basis for a risk management program in major surgery. Apart from
sparing the patient a serious complication, improvement of the quality of
care and anticipation of a medicolegal assessment were considered valuable
benefits of such an effort. It is described how the threat of
litigation--also in Europe-- may affect clinical practice. A definition of
surgical failure is described related to the five elements of risk
homeostasis: complexity, linkage, cascade, human factor and safety margins.
Limitations of risk control in the surgery of thoracoabdominal aneurysms
are described. Finally the role of perception of risks by patient and
doctor as well as the importance of informed consent and adequate
disclosure are described in respect of medical quality improvement and
litigation.
