Malpractice Litigation in Plastic Surgery: Can We Identify Patterns?

BACKGROUND: Malpractice litigation has a significant impact on healthcare costs and important professional implications for healthcare providers. OBJECTIVES: The authors sought to comprehensively characterize the litigation landscape in plastic surgery across its different subspecialties. METHODS: The authors utilized the Westlaw legal database to conduct a comprehensive search of malpractice cases in the United States in the following categories: cosmetic, reconstructive, hand, craniofacial, and gender affirmation surgery. They conducted both a Boolean and a natural language search to identify cases in which a plastic surgeon was the defendant. Data were analyzed employing descriptive statistics, logistic regression, and relative risk calculations. RESULTS: In total, 165 cases were included. Most surgeons accused of malpractice worked in a private setting (148 [90%]). Among the 22 (13%) cases that contained information on board certification status, most surgeons were board certified (17 [77%]). Resident involvement was mentioned in only 5 (3%) cases. The majority of cases were successfully defended by surgeons (98 [60%] vs 65 [40%]), particularly in craniofacial surgery (risk ratio: 1.54; P = 0.03; 95% CI: 1.03-2.3). Surgeons who successfully defended a case were more likely to benefit from summary judgment (P = 0.005). CONCLUSIONS: Malpractice litigation is commonplace in medical practice, and no specialty is spared. Legal outcomes were in favor of plastic surgeons in the majority of cases, particularly those that proceeded to summary judgment. Surgeons can avoid litigation by maintaining detailed office and surgical notes, always obtaining informed consent, adequately following and monitoring patients after surgery, and ensuring compliance by communicating frequently and effectively.

Understanding the Complexity of Early-Onset Dementia.

Dementia, particularly Alzheimer's disease, affects millions globally, with its prevalence increasing notably with age. Early-onset Alzheimer's disease, however, affects individuals under 65 years old. Unfortunately, diagnosing dementia in patients under 65 years old is quite challenging and is often delayed, missed, or wrong. Thus, we present the case of a 60-year-old female, with a medical history of hypothyroidism and presumed dementia on donepezil, who presented to the emergency department for agitation, dramatic change in personality and behavior, as well as cognitive decline that started in her late 50s. We discuss the importance of performing a thorough history and physical examination, as well as a comprehensive workup for patients who present with dramatic changes in behavior due to the wide range of potential diagnoses. While certain reversible causes, such as hypothyroidism, nutritional deficiencies, and polypharmacy, can be promptly identified and treated, chronic neurocognitive disorders such as Alzheimer's disease demand a timely evaluation for early multidisciplinary treatment to enhance patient outcomes.

Comparison of blade temperature dynamics after activation of Harmonic Ace scalpel and the Ultracision Harmonic Scalpel LCS-K5.

PURPOSE: To compare tip temperatures of the vibrating blades of the newer-generation Harmonic Ace device and the older-generation Ultracision Harmonic Scalpel LCS-K5. MATERIALS AND METHODS: Comparison of two different harmonic scalpel blades was performed by applying them to 3-mm strips of raw chicken breast at room temperature and measuring the temperature of the tip of the vibrating blade at 0.5-second intervals using a thermocouple. Following activation, the tip was allowed to passively cool to 30 degrees C each time before reactivation. Each device was tested at power settings of 3 and 5 after activation for 1 to 5 seconds. All measurements were performed 5 times. RESULTS: Compared to the older-generation Ultracision Harmonic Scalpel LCS-K5, the newer-generation Harmonic Ace was associated with higher tip temperatures at power level 5 at all times of activation (1-5 seconds), and at power level 3 at longer times of activation (3-5 seconds). The Harmonic Ace also takes longer to reach peak temperatures and can maintain blade hyperthermia for a longer period after activation for more than 3 seconds at power levels 3 and 5. CONCLUSION: The newer-generation Harmonic Ace may be potentially more effective in tissue dissection, but is associated with greater increases in peak temperatures and longer blade hyperthermia periods compared to the older-generation Ultracision Harmonic Scalpel LCS-K5. The difference is greater after longer periods of activation, and this may have more potential for collateral damage, particularly to nerves and bowel.

Cryoablation of small renal masses: assessment of the outcome at one institution.

OBJECTIVE: To report our 5-year experience with laparoscopic and percutaneous cryoablation (LCA and PCA) for managing small renal masses. PATIENTS AND METHODS: We retrospectively analysed patients undergoing LCA and PCA between October 2000 and March 2006 at our institution. After approval from the Institutional Review Board, charts were reviewed retrospectively for variables during and after CA, and for clinical outcomes, the latter including the efficacy of the procedure in achieving overall, cancer-specific and recurrence-free survival. RESULTS: In all, 78 patients had CA of 88 small renal masses, by LCA in 58 and PCA in 20. The median American Society of Anesthesiology score was 3 and the mean body mass index was 30 kg/m(2). All procedures were done under general anaesthesia, with a mean anaesthesia time of 220 min. The mean tumour size was 2.6 cm and the mean hospital stay was 2.1 days. At a mean follow-up of 19 months, the overall, cancer-specific and recurrence-free survival rates were 88.5%, 100% and 98.7%, respectively. Four patients required a repeat treatment due to persistent disease and one had progression to locally advanced disease. Five patients had complications during CA and seven had complications afterward. CONCLUSION: This study suggests that CA is a safe, minimally invasive treatment option for patients with small renal masses, at the intermediate-term follow-up.