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Contemporary Surgery SCALPEL & GAVELWhy do surgeons get sued?
Common causes revealedJon
van
Heerden,
MD;
Medical University of South Carolina, Charleston David
R.
Farley,
MDMayo Clinic College of Medicine, Mayo Graduate School of Medicine, Rochester, MN
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Our study of 91 malpractice cases taught us that injuries to adjacent structures were the primary culprit.
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284A change in pace is in order for this month’s Scalpel and Gavel. In our own survey of most errors involving general surgery, we found that injuries to adjacent organs or structures comprised the most common source of lawsuits (TABLE 1). We were reassured to find wrong-site surgery was rare (1%).
TABLE 1Surgical malpractice lawsuits: the common causes*
| Injury to adjacent organ/structure |
30% |
| Error in judgment |
21% |
| Bile duct injury (cholecystectomy) |
8% |
| Leak post-gastric bypass (morbid obesity)
|
8% |
| Postoperative gastrointestinal leak |
8% |
| Retained foreign object |
5% |
| Postoperative hemorrhage |
3% |
| Wrong-site surgery |
1% |
| Miscellaneous (technical, communication, surgical competence, postoperative myocardial infarct or cerebrovascular accident)
|
16% |
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Fast Track
Judgment errors were the second most common type after adjacent structure injuries.
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We reviewed lawsuits against general surgeons reported in Medical Malpractice Verdicts, Settlements & Experts.1 Each month we select illustrative cases from this publication, which touts itself as “The nation’s largest malpractice jury verdict reporter.” It covers not only general surgery and the surgical subspecialties (eg, plastic surgery), but has sections on diagnostic errors, drugs and devices, emergency medicine, gastroenterology, podiatry, rheumatology, psychiatry, and veterinary medicine.
We have learned much while perusing this journal each month. We have been saddened, angry, amazed, and, most often, humbled to realize the magnitude of what we surgeons do on a regular basis. The responsibility is awesome and the consequences of “things going awry” devastating—eg, death.
Surveying 91 cases
In this context, we thought that it might be of interest to summarize the lawsuits involving general surgery over a defined time frame. We did so for the period January through June 2007. What did we find? Ninety-one lawsuits involving general surgeons, as reported in the newsletter.
We then wondered which organs or adjacent structures had been injured. There were no big surprises (TABLE 2).
TABLE 2Adjacent structures most injured during operation*
| Nerves |
37% |
| Intestine |
20% |
| Urologic (kidney/ureter)
|
17% |
| Vascular |
10% |
| Miscellaneous (lymphatics, hepatic, gynecological, osseous)
|
16% |
The logical next question was: Which nerves were at risk? The most common were cervical nerves injured during thyroidectomies and cervical lymph node excisions (TABLE 3).
TABLE 3Specific nerves injured in 11 surgical malpractice cases*
| Location |
Nerve |
Injuries |
| Neck |
Spinal accessory, recurrent laryngeal |
2 |
| Nerve |
Ilioinguinal, lateral femoral cutaneous |
1 |
| Injuries |
Peroneal, vagus, median, sympathetic, facial |
1 |
What does this then mean? Was this a waste of time to do? We have no idea, but are hoping that you will enlighten us.
Will it make us even more careful to protect adjacent structures—nerves in particular? You bet! Maybe this exercise was not wasteful at all.
Wishing your patients safe surgery!
- Laska
L.
Medical Malpractice Verdicts, Settlements & Experts.
Nashville, TN: 2007;23(1-6).
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