Inside the courtroom: An analysis of malpractice litigation in gallbladder surgery.

BACKGROUND: Cholecystectomy is one of the most commonly performed operations in the United States, yet it still carries up to a 6% risk of major morbidity. Lawsuits are a major source of emotional, financial, and personal stress for surgeons. We sought to characterize malpractice claims associated with gallbladder surgery as well as define contributing factors and costs with these claims. METHODS: The Westlaw database (Thomson Reuters Corporation, Toronto, Canada) was queried for jury verdicts and settlements related to cholecystectomy and malpractice between 2000 and 2018. Data were abstracted from the case files and details of the settlements, jury verdicts, and factors related to the claims were assessed. RESULTS: Among 231 cases, a plaintiff verdict was reached in 45 (19.5%) and a defendant verdict was reached in 122 (53%); other cases were either settled (n = 29, 12%), dismissed (n = 31, 13%), or denied (n = 4, 2%). Plaintiff cases often involved young (median age, 44 years [interquartile range: 35-57]) female (n = 146, 63%) patients. The attending surgeon accounted for 59% of defendants. Procedural error (49%), wrongful death (18%), or failure to treat in a timely manner (13%) were the most commonly cited reasons for litigation. Among the 134 cases where a second surgical procedure was performed, the most common types of procedures were biliary tract repair (n = 82, 61%) and bowel repair (n = 16, 12%). The total cost of the claims over the study period was $22 million with a median payout of $500,000; the median time from operative event to final disposition was over 5 years (interquartile range: 4-7). CONCLUSION: A plaintiff verdict or settlement was reached in 1 in 3 cases, and large payouts were common. Minimizing procedural error and improving care of patients after cholecystectomy complications should be emphasized.

Cholecystectomy-related malpractice litigation: predictive factors of case outcome.

Complications following cholecystectomy may lead to malpractice litigation. Little research exists regarding cholecystectomy-related malpractice, the complications that lead to litigation, and the outcomes of such cases. This study is a retrospective analysis utilizing the legal database Verdictsearch (ALM Media Properties, LLC, New York, NY). Medical malpractice cases between July 2004 and November 2017 were identified using the search term "gallbladder." Case information was recorded, including patient information, medical details, trial outcome, and resulting payments. Of 46 cases examined, 39 went to trial with a favorable plaintiff (patient) verdict in 43% (20/46) and a favorable physician verdict in 41% (19/46) of the cases. Only 7% (3/46) of the cases resulted in a settlement, with 4% (2/26) concluding in mixed verdicts or arbitration. The mean plaintiff victory payment was $723,844 ± $1,119,457, while the mean settlement payment was $1,350,000 ± $563,471. Intraoperative care was the most frequently litigated phase of care (67%, 31/46 cases). Problematic visualization of the surgical field was the most frequent intraoperative allegation (67.7%, 21/46 cases). Cases of problematic visualization often resulted in favorable plaintiff trial victory (66.7% vs. 19% in defendant victory). Only 9.5% of the problematic visualization cases settled. Bile duct injuries accounted for 43.5% of the injuries (plaintiff victory rate 60.0%; mean payment $736,434 ± $1,365,424). In cholecystectomy litigation, allegations of problematic intraoperative visualization are both the most common allegation and the most likely to end in physician loss. Bile duct injuries remain the most frequent patient injury leading to cholecystectomy litigation.