During the study period (2012–18), approximately twice as many patients underwent surgery in the public health service (n ≈ 14 000) as in the private health service (n ≈ 7000) (Jorun Sandvik, Norwegian Association for Bariatric Surgery, personal communication). A total of 171 people (72 % women) with a mean age of 40 years applied for patient injury compensation following bariatric surgery. Of these, 134 had surgery in the public health service, and 37 had surgery in the private health service. A total of 44 (26 %) complaints were upheld, of which 25 related to cases in the public health service (19 % upheld), while 19 were in the private health service (51 % upheld). Four of the complaints concerned perioperative mortality, with two deaths in each of the latter categories.
Most claims for compensation were based on one or more of the following symptoms and problems: chronic pain, nutritional problems, diarrhoea, nausea, asthenia, unwanted weight change and hypoglycaemia. There was a degree of overlap in several of the listed symptoms and problems.
The most common single independent reason for the NPE upholding a complaint (n = 18) was that the bariatric procedure was performed on erroneous grounds (category 810: No indication for surgery); 3 of these were in the public health service and 15 were in the private health service (Table 1). In the decision to uphold a complaint, it was assumed that the patient a) had not sufficiently tried more conservative treatment before surgery, b) was not suitable for this type of surgery due to poor mental (n = 6) or physical health, c) was not adequately informed about the procedure and the extent of it, d) did not receive adequate follow-up, and/or e) did not meet the body mass index (BMI) criterion for the procedure according to good medical practice (n = 10). None of the patients had cited any of these factors as a basis for complaint in their application.
Other upheld complaints are attributed to surgical errors such as anastomotic leakage, rotation of the anastomosis, tears and perforations in the intestine or adjacent organs. These were the most common reasons for a complaint being upheld in the public health service.
Other reasons that provided a basis for compensation were premature discharge from hospital, use of analgesics that masked symptoms, lack of follow-up of test results and lack of understanding of the severity of symptoms and thus delayed recognition of surgical complications.
Several of the summaries did not include exact information about the surgical method, and were not therefore subject to analysis.