A ten-year analysis of the reasons for death following ambulatory surgery: Nine closed claims declared to the SHAM insurance.

Introduction: The constant development of ambulatory surgery (AS) raises the problem of monitoring patients after discharge and the risk of death in the case of delays in the management of a serious complication.

Patients And Methods: The aim of this retrospective study was to describe the deaths observed within the 30-day period following AS declared to the SHAM insurance (Société hospitalière d'assurance mutuelle) over the last 10 years.

Results: During the study period 33,962 claims were surgery-related and 11 were for deaths after AS. Two of the death claims were excluded from our study because they occurred after the first month. The surgeries concerned were tonsilectomy (3), cataract (2), inguinal hernia (2), varicose vein stripping (1) and laparoscopy (1). Death occurred on average 5.4 days after the AS, in intensive care (3), during hospitalisation (2), with emergency medical services (1), in an emergency department (1) or at home (2). Anaesthesia was directly implicated in 3 cases: anaphylactic shock (Diamox), pneumoperitoneum (gastric swelling) and hemoperitoneum (mismanagement of anticoagulants). 1 case was due to a pulmonary embolism and 5 to a surgical cause.

Discussion-conclusion: There was only one case where the complication was aggravated due to the delay of care provision and this was because of a lack of information on the complications requiring an emergency return (abdominal pain after laparoscopy). In all the other cases, death would also probably have occurred during conventional hospitalisation, either because it was unavoidable or because the patient was too far from the surgery.