Patient Safety in Surgery

Featured Article: Medical negligence compensation claims in knee meniscal surgery in Norway: a cross-sectional study

Arthroscopic partial meniscectomy is one of the most common surgical procedures in the world. However, the value of this elective surgery has come under intense scrutiny in the last decade based on insights from the prospective randomized sham surgery-controlled “Finnish Degenerative Meniscal Lesion Study” (FIDELITY) which demonstrated that the one- to two-year outcomes were no better in patients undergoing a partial meniscectomy versus a sham surgical procedure (Sihvonen R, et al. N. Engl. J. Med. 2013, 369:2515-24). This notion was confirmed by subsequent systematic reviews and meta-analyses of the literature leading to a widespread consensus that arthroscopic partial meniscectomy in the middle age patient population is reflective of “low-value” care and rarely indicated or justified compared to conservative measures with symptomatic treatment and physical therapy (Stahel PF, et al., JAMA Surg. 2018, 153:494-6).

This featured article sheds further light on the potential sequelae of arthroscopic meniscectomy regarding potentially preventable postoperative complications from a surgical procedure that may not have been indicated in the first place. The authors reviewed a total of 372 malpractice claims from a national Norwegian Patient Registry originating from meniscal surgery during a 10-year time-window from 2010 to 2020. The prevalent reasons for patients to file a compensation claim were pain (n=114), postoperative infection (n=98), wrong technique (n=38), impaired function (n=25), nerve injury (n=22), and alleged “wrong indication” or “no indication” for surgery (n=16). These insights confirm the notion that any surgical procedure, whether indicated or not, imposes an imminent underlying risk for severe surgical complications and adverse patient outcomes. Even though the incidence of litigation claims in this study was low (0.3%), there was an impressive number of 119,528 patients receiving potential “low value” surgical care by arthroscopic meniscectomy, of which 372 patients filed a notice of claim. The number of patients who sustained harm from this procedure – in absence of filing a claim – is likely significantly higher. This study should be a “wake-up call” for surgeons to reconsider surgical indications for selected elective procedures where the evidence-based literature demonstrates a lack of benefit from surgery compared to standard non-operative treatment.