Litigation in orthopedic surgery: What can we do to prevent it? Systematic analysis of 126 legal actions involving four university hospitals in France

Mouton, Jordane; Gauthé, Rémi; Ould-Slimane, Mourad; Bertiaux, Simon; Putman, Sophie; Dujardin, F.

doi:10.1016/j.otsr.2017.11.002

Cited by 31 publications

(25 citation statements)

References 23 publications

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“…Many authors have described different results and increasing legal actions against surgeons. Reasons, such as poor quality of patient-physician relationship or the trend of considering medicine as a service that requires financial compensation, have been reported [2][3][4][5]18]. Agout et al found a significant increase in legal actions, from 9 cases in 2006 to 28 cases in 2015 (p = 0.04).…”

Section: Discussionmentioning

confidence: 99%

“…The field of orthopedic surgery has a high incidence of medical malpractice claims, resulting in a relative risk of 99% for each surgeon to receive at least one claim in his/her career [1]. Many publications have described an increase in the number of lawsuits against medical professionals across all fields of practice [2][3][4][5]. The increasing demands on the patient side potentially influenced by incorrect information communicated through the internet or social media platforms, the escalating willingness to regress and litigate, and the misconception about the limits of the medically possible outcomes are considered potential reasons [6][7][8][9].…”

Section: Introductionmentioning

confidence: 99%

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Litigations in orthopedics and trauma surgery: reasons, dynamics, and profiles

Gathen

Jaenisch

Fuchs

et al. 2021

Arch Orthop Trauma Surg

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Background In recent literature, the increasing number of medical litigations, both in terms of the number of cases being filed and the substantive costs associated with lawsuits, has been described. This study aims to provide an overview of the profile of litigation for orthopedic and trauma surgery to describe the differences and the development of the number of cases over time. Patients and Materials A retrospective review of all litigations between 2000 and 2017 was conducted using the institutional legal database. The causes of litigation were documented and classified into seven major categories. In addition to plaintiff characteristics, the litigation outcomes and the differences between emergency and elective surgery were analyzed. Results A total of 230 cases were evaluated. The mean age of the plaintiffs was 44.6 ± 20.1 years, and 56.8% were female. The main reasons for litigation were claimed inappropriate management (46.1%), misdiagnosis (22.6), and poor nursing care (8.3%). Significantly more litigations were filed against surgeons of the orthopedic subspecialty compared with trauma surgeons (78%; p ≤ 0.0001). There were significantly fewer litigations per 1000 cases filed overall in 2009–2017 (65% less; p = 0.003) than in 2000–2008. Conclusion Our results could not confirm the often-stated trend of having more litigations against orthopedic and trauma surgeons. Although the absolute numbers increased, the number of litigations per 1000 patients treated declined. Patients who underwent elective surgery were more likely to file complaints than emergency patients.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Litigations in orthopedics and trauma surgery: reasons, dynamics, and profiles

Gathen

Jaenisch

Fuchs

et al. 2021

Arch Orthop Trauma Surg

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“…Our survey suggests that medical-legal concerns are driving preoperative antibiotic decisions for those hand surgeons who are not following the current best evidence available. Pressure from medical litigation has changed the way hand surgeons practice, 37,38 and considering that SSI is a common cause of litigation, 39 medical-legal concern may be seen as a reasonable cause for surgeons to give antibiotics. Although it is understandable for surgeons to tailor their practice in an attempt to reduce the likelihood of litigation, it is relieving to note that claims against hand surgeons in general are rare and most often unsuccessful.…”

Section: Discussionmentioning

confidence: 99%

Antibiotic Use in Hand Surgery: Surgeon Decision Making and Adherence to Available Evidence

Dunn

Means

Desale

et al. 2018

Hand (New York, N,Y.)

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Background: There are no clearly defined guidelines from hand surgical societies regarding preoperative antibiotic prophylaxis. Many hand surgeons continue to routinely use preoperative prophylaxis with limited supporting evidence. This study aimed to determine for which scenarios surgeons give antibiotics, the reasons for administration, and whether these decisions are evidence-based. Methods: An anonymous 25-question survey was e-mailed to the 921-member American Society for Surgery of the Hand listserv. We collected demographic information; participants were asked whether they would administer antibiotics in a number of surgical scenarios and for what reasons. Respondents were broken into 3 groups based on when they said they would administer antibiotics: Group 1 (40 respondents) would give antibiotics in the case of short cases, healthy patients, without hardware; group 2 (9 respondents) would not give antibiotics in any scenario; and group 3 (129 respondents) would give antibiotics situationally. The Fisher exact test compared demographic variables, frequency of use, and indications of antibiotic prophylaxis. Results: Of the 921 recipients, 178 (19%) responded. Demographic variables did not correlate with the antibiotic use group. Operative case time >60 minutes, medical comorbidity, and pinning each increased antibiotic use. Group 1 respondents were more likely to admit that their practice was not evidence-based (74.4%) and that they gave antibiotics for medical-legal concern (75%). Twenty-two percent of respondents reported seeing a complication from routine prophylaxis, including Clostridium difficile infection. Conclusions: Antibiotics are still given unnecessarily before hand surgery, most often for medical-legal concern. Clear guidelines for preoperative antibiotic use may help reduce excessive and potentially inappropriate treatment and provide medical-legal support.

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“…Poor communication plays a major role in the decision to litigate. [16][17][18] Yet there is a known gap in doctors' and patients' assessment of a doctor's communication skills whereby doctors tend to overestimate their abilities. 18 Even when doctors adequately perform patient-centred, coded behaviours, it is the patients' perception of the doctors' behaviour rather than the behaviours themselves that predict outcomes such as satisfaction and judgement of physicians' informativeness.…”

Section: Open Accessmentioning

confidence: 99%

Interpersonal factors contributing to tension in the Chinese doctor–patient–family relationship: a qualitative study in Hunan Province

Xiao¹,

Wang²,

Edelman³

et al. 2020

BMJ Open

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ObjectiveTo identify actionable barriers to communication that contribute to tension in the Chinese doctor–patient–family relationship (DPFR) among surgeons, surgical patients and their family members.DesignWe employed qualitative research methods using in-depth, semistructured interviews in Mandarin and English and conducted preoperatively and postoperatively. Interviews were audio recorded, transcribed and translated into English. Data were analysed using thematic analysis.SettingAn urban, tertiary-level teaching hospital in Hunan Province, China.ParticipantsWe recruited a purposive sample of 11 inpatients undergoing the same minor surgery, 9 of their family members and 9 surgeons between June and August 2015.ResultsWe identified three emergent themes. First, trust degradation occurred before and during the healthcare experience. Second, the healthcare-seeking experience for patients and family members was marked by unmet expectations for achieving a basic understanding of the illness as well as powerlessness over their situation. Third, societal pressures on doctors contributed to a state of learned helplessness.ConclusionsOur findings suggest that tension in the DPFR is associated with interpersonal and structural challenges, with communication playing an important role. Reforms at all levels are needed to promote a more patient-centred experience while ensuring the well-being and security of providers.

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Litigation in orthopedic surgery: What can we do to prevent it? Systematic analysis of 126 legal actions involving four university hospitals in France

Abstract: IV (retrospective study).

Cited by 31 publications

References 23 publications

Litigations in orthopedics and trauma surgery: reasons, dynamics, and profiles

Litigations in orthopedics and trauma surgery: reasons, dynamics, and profiles

Antibiotic Use in Hand Surgery: Surgeon Decision Making and Adherence to Available Evidence

Interpersonal factors contributing to tension in the Chinese doctor–patient–family relationship: a qualitative study in Hunan Province

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