BN SO40 - Increasing incidence of medicolegal claims in the NHS for bile duct injury in spite of 30 years of experience and training

Abstract Background Bile duct injury (BDI) in cholecystectomy is the most commonly recognised complication occurring in 0.5-1.4% of cases and is associated with significant morbidity and mortality. Despite the increasing number of cholecystectomies and falling number of bile duct injuries due to both surgical experience and recognition of the issue, there appears to be increasing number of payouts by NHS England. We investigated the trend in claims, their underlying cause, stage in procedure where they occurred in the past 20 years to identify areas where improvements could be made, for better patient outcomes and to reduce the medicolegal burden to the NHS. Method Data was obtained following a freedom of information request from NHS Resolution UK for cases of bile duct injury. Data analysis was performed on years 2001-2021 to examine the number of claims, their underlying cause and stage in procedure where they occurred as well as average damages awarded and cost to the NHS. Results In 2001 there were 11 claims made (costing £644,000) which rose to 28 in 2021 (costing £7,424,000). 400 claims were successful out if 508. The commonest being intraoperative error (49%) followed by operator error (11%) and delay in treatment (8%). The most expensive type of claim arose from intraoperative complications costing a total of £42,836,000 over the period. Pre-operative delays and inadequate patient consent cost the NHS £7,236,000, whilst delays in recognition of BDI cost £8,000,000 between 2001 and 2021. Conclusion Although settled cases of BDI have risen in the last 20 years despite improvement in training and techniques of cholecystectomy, they remain significantly below the anticipated numbers. Prompt recognition of anatomy and intraoperative complication as well as effective post-op management are essential for better patient outcomes and maintaining this low claim rate. Surgeon training within the NHS is crucial but appropriate case selection is the key to patient safety. Laparoscopic cholecystectomy can be a complex operation, worsened by delays in treatment , requires an experienced UGI surgeon or supervision by a consultant and never considered simple or routine operation.