Neurosurgical Malpractice Litigation: A Systematic Review and Meta-Analysis.

BACKGROUND: Neurosurgery has 1 of the highest risks for medical malpractice claims. We reviewed the factors associated with neurosurgical malpractice claims and litigation in the United States and reported the outcomes through a systematic review of the literature. METHODS: We conducted a systematic review of the literature according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines using the Medline, Embase, Cochrane, PubMed, and Google Scholar databases. We sought to identify pertinent studies containing information about medical malpractice claims and outcomes involving neurosurgeons in the United States. RESULTS: We identified 15 retrospective studies spanning from 2002 to 2023 that reviewed over 7890 malpractice claims involving practicing neurosurgeons in the United States. Disparities were evident in neurosurgical litigation, with 474 cases linked to brain-related surgeries and a larger proportion, 1926 cases, tied to spine surgeries. The most commonly filed claims were intraprocedural errors (37.4%), delayed diagnoses (32.1%), and failure to treat (28.8%). Less frequently filed claims included misdiagnosis or choice of incorrect procedure (18.4%), occurrence of death (17.3%), test misinterpretation (14.4%), failure to appropriately refer patients for evaluation/treatment (14.3%), unnecessary surgical procedures (13.3%), and lack of informed consent (8.3%). The defendant was favored in 44.3% of claims, while in 31.3% of lawsuits were dropped, 17.7% of verdicts favored the plaintiff, and 16.6% reached an out of court settlement. Only 3.5% of lawsuits found both parties liable. CONCLUSION: Neurosurgery is a high-risk specialty with 1 of the highest rates of malpractice claims. Spine claims had a significantly higher rate of filed malpractice claims, while cranial malpractice claims were associated with higher litigation compensation. Predictably, spinal cord injuries play a crucial role in predicting litigation. Importantly, nonsurgical treatments are also a common source of liability in neurosurgical practice.

Professional Practice and Neurosurgery: What Every Neurosurgeon Should Know about Malpractice

Introduction The objective of the present study was to review the epidemiological aspects of malpractice in neurosurgery and to identify preventive measures regarding malpractice for neurosurgeons. Methods The following terms (alone or in combination) were searched in the PubMed and Biblioteca Virtual em Saúde databases: neurosurgery (neurocirurgia), lawsuits (ações judiciais), malpractice (erro médico), and litigation (litígio) and identifying studies on these topics published from 2000 to April 2018. Literature Review In Brazil, 6.9% of the physicians are sued per year. The most common type of malpractice alleged in litigation is negligence. According to the literature, the neurosurgical disease that has sparked the most litigation is spinal disease. The outcomes of these cases vary: sometimes the neurosurgeon prevails, and at other times the plaintiff prevails. To prevent or reduce malpractice claims, the neurosurgeon should take the following precautions: 1. follow medical protocols; 2. perform surgeries in an environment consistent with good medical practice; 3. evaluate and monitor antibiotic prophylaxis; 4. develop a good relationship with the patient based on ethics, good faith and transparency; 5. request the presence of the patient and of his or her family when there is a problem in order to didactically explain the case; 6. keep good medical records to document all of the actions performed (informed consent and description of the surgery and of the pre and postoperative); 7. always seek technical improvement (continuing education/professional development); 8. in the case of attending physicians, monitor patients, treating any postoperative complications; and 9. conduct multidisciplinary team meetings to optimize treatment decisions and to share responsibility for making difficult decisions.

Formación en cirugía de columna en España. Estado actual y futuro / Training in spine surgery in Spain: Current state and the future

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Análisis de las sentencias judiciales contra neurocirujanos resueltas en segundainstancia en España entre 1995 y 2007 / Analysis of Judicial Sentences Against Neurosurgeons Resolved in Second Court of Justice in Spain in the Period from 1995 to 2007

Objetivos. Con el fin de identificar los factoresrelacionados con las condenas judiciales contra neurocirujanos,el presente estudio analiza todas las sentenciasemitidas en segunda instancia en España contraneurocirujanos en el periodo de 1995 al 2007.Material y método. De un total de 1899 sentencias desegunda instancia o última durante el periodo de 1995a 2007 emitidas en España se han escogido 61 que cumplenlos criterios de inclusión para nuestro estudio. Sehan cumplimentado 25 variables en la ficha de recogidade datos. Se ha realizado con ellas un completo estudiodescriptivo y comparativo, además de un análisis de latipología de las demandas, las circunstancias y los profesionalesimplicados.Resultados. En un tercio de los casos se apreció completamal praxis. En relación a las condenas, se absolvióaproximadamente en la mitad de los casos, siendo lasresueltas con condena 1/5 de ellas de carácter penaly 4/5 indemnizatorias. Las cuantías indemnizatoriaspredominan en el rango de 60.000 a 600.000 euros.En un 17% de las demandas se apreció deficiencia enla información o el consentimiento. El 62,5% de lasintervenciones de nuestra muestra se produjeron en laregión anatómica de la columna vertebral siguiéndoleen frecuencia la región craneal con un 28,6%. De lasconsecuencias del procedimiento quirúrgico las secuelaspermanentes mayores constituyen el 40% de loscasos y el fallecimiento el 22%.Conclusiones. Es rentable dedicar tiempo a la relacióncon el paciente, incluyendo el consentimiento informadoverbal, que debe ser refrendado por la (..) (AU)

Objectives. With the aim of identifying the factorsrelated to sentences against neurosurgeons, we haveanalyzed all the sentences issued in the second courtof justice in Spain against neurosurgeons in the periodfrom 1995 to 2007.Material and methods. Of a total of 1899 sentences ofthe second or last appeal, during the period from 1995to 2007 issued in Spain, 61 were chosen which fulfill thecriteria to be included in our study. 25 variables wereincluded on the record of compiled data. A completedescriptive and comparative study was elaborated, aswell as an analysis of the type of suits, circumstances,and professionals involved.Results. In a third of the cases, complete malpraxiswas identified. In regards to the sentences, they wereabsolved in approximately half the cases, resolved withone fifth of the cases being penal, and four fifths withcompensation. Indemnity quantities range from 60,000to 600,000€. Deficiency of information or consent wasnoted in 17% of lawsuits. 62.5% of operations in oursample were on the anatomic region of the vertebralcolumn followed in frequency by the cranial regionwith 28.6%. Consequences of surgical procedure includedmajor permanent sequelae in 40% of the cases anddeath in 22%.Conclusions. It is wise to invest time to deal withpatients, including the verbal informed consent, whichmust be confirmed by the written informed consent form.It is also important to leave a written proof of (..) (AU)