Malpractice in colorectal surgery: a review of 122 medicolegal cases

Gordhan, Chirag; Anandalwar, Seema P.; Son, Julie Y.; Ninan, Gigio K.; Chokshi, Ravi J.

doi:10.1016/j.jss.2015.05.032

Cited by 18 publications

(12 citation statements)

References 36 publications

(32 reference statements)

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“…With fewer patients presenting with operable colorectal cancer in many low‐HDI countries and fewer formal training opportunities, access to subspecialist colorectal services is limited. High baseline mortality rates, inadequate provision of critical care support and insufficient medicolegal protection may also promote risk‐averse practices. Stapling devices may be unaffordable for both patient and provider in many LMICs, meaning that only selected patients have access to these techniques.…”

Section: Discussionmentioning

confidence: 99%

Global variation in anastomosis and end colostomy formation following left‐sided colorectal resection

Collaborative

2019

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BackgroundEnd colostomy rates following colorectal resection vary across institutions in high‐income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left‐sided colorectal resection.MethodsThis study comprised an analysis of GlobalSurg‐1 and ‐2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left‐sided colorectal resection within discrete 2‐week windows. Countries were grouped into high‐, middle‐ and low‐income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model.ResultsIn total, 1635 patients from 242 hospitals in 57 countries undergoing left‐sided colorectal resection were included: 113 (6·9 per cent) from low‐HDI, 254 (15·5 per cent) from middle‐HDI and 1268 (77·6 per cent) from high‐HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low‐ compared with middle‐ and high‐HDI settings. The association with colostomy use in low‐HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001).ConclusionGlobal differences existed in the proportion of patients receiving end stomas after left‐sided colorectal resection based on income, which went beyond case mix alone.

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Section: Discussionmentioning

confidence: 99%

Global variation in anastomosis and end colostomy formation following left‐sided colorectal resection

Collaborative

2019

BJS Open

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“…Results include relevant case documents such as jury verdicts, settlements, and case summaries, thereby allowing for review of litigated cases. The database is updated regularly with content supervised by attorney editors responsible for accurately categorizing and summarizing cases, and has had extensive application in analyses of medical malpractice [11-13].…”

Section: Methodsmentioning

confidence: 99%

A Qualitative Analysis of Malpractice Litigation in Cardiology Using Case Summaries Through a National Legal Database Analysis

Patel

Rynecki

Eidelman

et al. 2019

Cureus

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IntroductionPhysicians are increasingly practicing defensive medicine as a response to society’s litigious climate. This study sought to characterize cardiology malpractice claims and elucidate the allegations underlying the use of defensive medicine.MethodsThe WestlawNext™ database was queried to obtain state and federal jury verdicts and settlements related to medical malpractice and cardiology that occurred in the United States between 2010 and 2015. Cardiology cases were identified using the search terms “medical malpractice” and “cardiology” and reviewed by two individuals utilizing available case documents. Duplicate and nonpertinent cases were excluded. Binary logistic regression models were created to predict the likelihood of defendant verdict, plaintiff verdict, and settlement based on the various reasons for litigation cited.ResultsInclusion criteria were met in 166 cases. The plaintiffs were predominantly male (94 cases; 56.6%), and the average patient age was 53.3±17.5 years. More than half of the cases involved a cardiologist as a defendant. The most common reasons for litigation were: failure to treat (129; 77.7%), failure to diagnose (115; 69.3%), failure to refer/order diagnostic tests (107; 64.5%), and patient death (118; 71.1%). Among cases tried for failure to diagnose, the most commonly missed diagnosis was myocardial infarction. Cases most commonly resulted in a defendant verdict (94; 56.6%). However, odds of a plaintiff verdict were significantly higher when failure to diagnose was alleged with an odds ratio (OR) of 7.60 (95% confidence interval 1.14 - 50.87, p = 0.0365).ConclusionsFailure to diagnose remains a commonly alleged base for litigation. In conclusion, our analysis suggests increased training for non-cardiologists in the recognition of the acute coronary syndrome and enhanced awareness of inherent biases among all physicians may facilitate reducing missed diagnoses.

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“…Westlaw and WestlawNext have been used repeatedly to analyze medical malpractice litigation. 6,15,16,[18][19][20] Nexis Uni (formerly LexisNexis Academic) is a subscription-based database which provides access to more than 17 000 business and legal sources from LexisNexis. Nexis Uni has 3 primary collections, 1 of which contains full-text legal documents, including US Federal and State court cases, and law reviews from the late 18th century to present.…”

Section: Data Sourcesmentioning

confidence: 99%

“…Nevertheless, the databases used remain useful tools and have shown their value in prior litigation analyses with similar methodology. 6,15,16,[18][19][20] To the best of our knowledge, this is the first comprehensive review of malpractice litigation specifically focusing on rhinoplasty. The findings presented herein should serve to educate and benefit those performing such procedures in the future…”

Section: Limitationsmentioning

confidence: 99%

Analysis of Factors Associated With Malpractice Litigation in Rhinoplasty

et al. 2019

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Rhinoplasty, the third most common cosmetic surgical procedure in the United States, represents the second most litigated facial plastic surgery procedure. Previous examinations of litigation specific to rhinoplasty are limited. The objective of this study was to comprehensively evaluate rhinoplasty malpractice litigation over the past 30 years and to investigate the financial burden of medical malpractice litigation associated with rhinoplasty, as well as factors that contribute to litigation and negative defendant outcomes. Jury verdict and payment reports related to rhinoplasty malpractice litigations over the past 30 years (1988-2018) were obtained using the WestlawNext and Nexis Uni subscription-based legal databases. The term “malpractice” was searched in combination with “rhinoplasty” and various names associated with the procedure. Cases included in the analysis were reviewed for outcomes, verdict payments, defendant specialty, and allegations raised in proceedings. Of the 46 cases identified, 12 (26%) were resolved with a plaintiff verdict payment. The median payment awarded was $127 500 (standard deviation, $96 590.63). The surgeon specialties found for 35 cases included otolaryngology (17 [49%]), plastic surgery (13 [37%]), facial plastic surgery (3 [9%]), and oral/maxillofacial surgery (OMFS; 2 [6%]). A greater proportion of cases involving otolaryngologists were resolved with payment compared with cases involving plastic surgeons (4 [24%] vs 1 [8%]), though this difference did not reach statistical significance ( P = .26). The most common allegations raised among the 46 cases were poor cosmesis (20 [43%]), intraoperative negligence (18 [39%]), inadequate informed consent (13 [28%]), and nasal function deficits (13 [28%]). Cases had a higher likelihood of being resolved in payment when allegations of cosmetic deformity (7%, 95% confidence interval [CI], −17.55 to 31.91) and nasal function deficit (17%, 95% CI, −9.29 to 45.32) were present, nevertheless these findings did not reach statistical significance ( P = .60 and P = .24, respectively). Rhinoplasty malpractice litigation resulting in payments can create substantial financial burden for the defendant. Common factors cited by plaintiffs for pursuing rhinoplasty malpractice litigation included cosmetic deformity, intraoperative negligence, lack of informed consent, and nasal function deficit. Cosmetic deformity and nasal function deficit allegations tended to result in negative defendant outcomes, though these findings are inconclusive. Our findings reinforce the importance of physician-patient communication, including conducting a comprehensive informed consent process, to limit or avoid postsurgical allegations.

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Malpractice in colorectal surgery: a review of 122 medicolegal cases

Cited by 18 publications

References 36 publications

Global variation in anastomosis and end colostomy formation following left‐sided colorectal resection

Global variation in anastomosis and end colostomy formation following left‐sided colorectal resection

A Qualitative Analysis of Malpractice Litigation in Cardiology Using Case Summaries Through a National Legal Database Analysis

Analysis of Factors Associated With Malpractice Litigation in Rhinoplasty

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