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Master's Dissertation
DOI
https://doi.org/10.11606/D.17.2020.tde-04012021-105026
Document
Author
Full name
Roberto Mundim Porto Filho
E-mail
Institute/School/College
Knowledge Area
Date of Defense
Published
Ribeirão Preto, 2020
Supervisor
Committee
Santos, José Sebastião dos (President)
Andreollo, Nelson Adami
Silveira, Sebastiao Sergio da
Title in Portuguese
Fatores associados à vontade de litigar e ao litígio judicial após lesão iatrogênica da via biliar
Keywords in Portuguese
Colecistectomia laparoscópica
Colelitíase
Erro médico
Judicialização
Lesão Iatrogênica da via biliar
Lesões do ducto biliar
Litígios
Via biliar
Abstract in Portuguese
Introdução: Os fatores associados aos questionamentos éticos e jurídicos por lesão iatrogênica da via biliar (LIVB) podem oferecer subsídios para orientar a relação médico/paciente, fundamentar pareceres e decisões nas litigâncias. Objetivo: Identificar fatores associados à vontade de litigar e ao litígio judicial após LIVB. Método: Estudo dos casos de LIVB tratados em hospital público, de ensino e terciário, entre os anos de 2003 e 2018, mediante entrevistas com pacientes e médicos visando a caracterização das circunstâncias assistenciais, dos resultados do tratamento e dos processos jurídicos cogitados e peticionados. As associações foram verificadas por meio do teste exato de Fisher, com adoção do nível de significância de 0,05. Resultados: Dentre os 144 pacientes com LIVB tratados, 71 foram estudados: 33 (46,5%) foram operados por colelitíase sintomática, 31 (43,7%) por colecistite aguda e 7(9,8%) por colelitíase assintomática. A idade foi, em média, de 46,14 (18-75) anos; 62 (87,3%) pacientes eram do sexo feminino, e 59 (83,0%) tinham baixa e média escolaridade. O encaminhamento para o tratamento da LIVB foi coordenado pelo cirurgião em 50 (70,4%) pacientes, pelos familiares em 11 (15,5%) e pela regulação assistencial em 9 (12,7%). A obstrução biliar foi resolvida em 58 (81,7%) dos casos; 13 (18,3%) evoluíram com colangite e 2 (2,8%) com cirrose biliar e hipertensão portal. O tratamento foi considerado excelente e bom para 58 pacientes (81,7%). A cogitação de litígio foi a vontade de 16 (22,5%) pacientes e associou-se, significativamente, a menor renda familiar, ao não preenchimento do termo de consentimento livre esclarecido, à ausência de conhecimento dos riscos e complicações cirúrgicas, à falta de orientação no pós-operatório e à persistência de alterações bioquímicas compatíveis com colestase. O litígio foi a opção para 7 pacientes (9,9%) e associou-se, significativamente, à menor possibilidade de tratamento endoscópico, à dúvida sobre a evolução da LIVB e à persistência de alterações bioquímicas compatíveis com colestase. Dentre os 7 processos judiciais, 2 foram julgados improcedentes, 2 estavam nas fases iniciais e 3 ocorriam em segredo de justiça. Conclusão: A intenção de litigar e a litigância após LIVB foram elevadas e a relação médico/paciente transparente com a boa governança clínica parecem ser a melhor forma de mitigá-las.
Title in English
Factors associated with the intent to litigate and with legal ltigation after iatrogenic injury to the bile duct
Keywords in English
Bile duct
Bile duct injuries
Cholelithiasis
Judicialization
Laparoscopic cholecystectomy
Latrogenic bile duct injury
Litigations
Medical error
Abstract in English
Introduction: The factors associated with ethical and legal questions due to iatrogenic bile duct injuries (IBDI) may offer subsidies to the doctor/patient relationship and provide a basis for opinions and decisions in litigations. Objective: To identify factors associated with the intent to litigate and with legal litigation after IBDI. Method: This was a study of IBDI cases treated at a tertiary care teaching public hospital between 2003 and 2018, based on the application of questionnaires for patients and doctors aiming at the characteriation of care circumstances, of the results of treatment and of the considered and petitioned legal processes. The associations were determined by the Fisher exact test, with the level of significance set at 0.05. Results: Seventy-one of the 144 patients treated for IBDI were studied: 33 (46.5%) were operated for symptomatic cholelithiasis,31 (43.7%) for acute cholelithiasis, and 7 (9.8%) for asymptomatic cholelithiasis. Mean age was 46.14 (18-75) years; 62 (87.3%) patients were females, and 59 (83.0%) had low and medium schooling. Referral for IBDI treatment was coordinated by the surgeon in 50 (70.4%) patients, by relatives in 11 (15,5%), and by assistance regulation in 9 (12.7%). Bile obstruction was resolved in 58 (81.7%) cases; 13 (18.3%) progressed to cholangitis and 2 (2.8%) to biliary cirrhosis and portal hypertension. Treatment was considered excellent and good for 58 patients (81.7%). The intent to litigate was expressed by 16 (22.5%) patients and was significantly associated with lower family income, with failure to give written informed consent, with lack of knowledge of the surgical risks and complications, with lack of postoperative counseling, and with the persistence of biochemical changes compatible with cholestasis. Litigation was the option for 7 patients (9.9%) and was significantly associated with a lower possibility of endoscopic treatment, with doubts about the evolution of IBDI and with the persistence of biochemical changes compatible with cholestasis. Of the 7 legal trials, 2 were dismissed, 2 were in the initial phases, and 3 were occurring under secret. Conclusion: The intent to litigate and litigation after IBDI were high and a transparent doctor/patient relationship with good clinical conduct appeared to be the best way to mitigate them.
 
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Publishing Date
2021-01-28
 
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