Trends and Risk Factors in Orthopedic Lawsuits: Analysis of a National Legal Database.

Orthopedic surgeons frequently encounter medical malpractice claims. The purpose of this study was to assess trends and risk factors in lawsuits brought against orthopedic surgeons using a national legal database. A legal research service was used to search publicly available settlement and verdict reports between 1988 and 2013 by terms "orthopaedic or orthopedic" and "malpractice." Temporal trends were evaluated, and logistic regression was used to identify independent risk factors for case outcomes. A total of 1562 publicly reported malpractice cases brought against orthopedic surgeons, proceeding to trial during a 26-year period, were analyzed. The plaintiffs won 462 (30%) cases, with a mean award of $1.4 million. The frequency of litigation and pay-outs for plaintiffs increased 215% and 280%, respectively, between the first and last 5-year periods. The mean payout for plaintiff-favorable verdicts was highest in pediatrics ($2.6 million), followed by spine ($1.7 million) and oncology ($1.6 million). Fracture fixation (363 cases), arthroplasty (290 cases), and spine (231 cases) were the most commonly litigated procedures, while plaintiffs were most successful for fasciotomy (48%), infection-treating procedures (43%), and carpal tunnel release (37%). When analyzing data by state and region, adjusted for population, northeastern states had a higher frequency of lawsuits. Malpractice liability has increased during the past 3 decades while orthopedic surgeons continue to win most of the cases making it to court. As patients search for medical care via publicly available information, it is important for orthopedic surgeons to understand what aspects of their own practice carry different risks of litigation. [Orthopedics. 2019; 42(2):e260-e267.].

Metabolic syndrome and shoulder arthroplasty: epidemiology and peri-operative outcomes.

PURPOSE: Little is known about metabolic syndrome in the peri-operative shoulder surgery setting. We sought to determine the prevalence of metabolic syndrome in patients undergoing shoulder arthroplasty, and to characterize its relationship with in-hospital adverse events, prolonged length of stay, and non-routine disposition. METHODS: Using discharge records from the 2002-2011 Nationwide Inpatient Sample, temporal trends were assessed and multivariable logistic regression modeling was used to measure the association of metabolic syndrome with peri-operative outcomes. RESULTS: The prevalence of metabolic syndrome increased by 257 % from 2002 to 2011 (4.2 to 15.0 %). Metabolic syndrome was associated with increased aggregate morbidity (OR 1.34, 95 % CI 1.30-1.38), including acute renal failure (OR 1.51, 95 % CI 1.41-1.63), surgical site infection (OR 1.41, 95 % CI 1.16-1.71), myocardial infarction (OR 1.32, 95 % CI 1.12-1.55), acute posthemorrhagic anemia (OR 1.30, 95 % CI 1.26-1.34), and pulmonary embolism (OR 1.27, 95 % CI 1.06-1.52). It was also associated with prolonged hospital stay (OR 1.13, 95 % CI 1.10-1.16), non-homebound discharge (OR 1.29, 95 % CI 1.26-1.32), and increased blood transfusion use (OR 1.09, 95 % CI 1.06-1.13). CONCLUSIONS: Metabolic syndrome is increasing rapidly among shoulder arthroplasty patients and is associated with considerable peri-operative morbidity and resource utilization. Greater awareness of metabolic syndrome and its health consequences may contribute to improvements in the peri-operative management of shoulder arthroplasty patients.