G. E. Savulionyte1,2, F. Saeed1, K. Oh1,2, H. M. Ross1 1Temple University,Department Of Surgery,Philadelpha, PA, USA 2State University Of New York At Buffalo,Department Of Surgery,Buffalo, NY, USA
Introduction:
Medical malpractice presents a challenge for the delivery and cost of healthcare provided by physicians. Little prior work has been done to investigate malpractice litigation in the context of colorectal procedures. The purpose of this study is to elucidate the outcomes and associated factors of malpractice involving colorectal procedures.
Methods:
Key phrases “colon and surgery” and “rectal and surgery” were searched in the national legal database Westlaw. Search was limited to all state and federal cases up to and including the year 2017. Inclusion criteria were cases with allegations involving a colorectal procedure. Cases involving workers compensation, prisoner negligence, social security, failure to diagnose colorectal pathology, colonoscopies, and pediatric procedures were excluded. Chi-square or fisher-exact tests were performed for sub-analysis.
Results:
A total of 4294 cases were reviewed, and 201 cases were included in the final analysis. Most commonly named physicians were general surgeons (63%, 127/201), followed by colorectal surgeons (17%, 34/201), other surgical specialists (7%, 13/201), primary care physicians (6%, 12/201), and EM physicians (2%, 2/201). Pre-operative allegations were cited in 31% (62/201) of cases, intra-operative allegations in 45% (91/201) of cases, and post-operative allegations in 36% (73/201) of cases. Of known verdicts, 81% (110/135) were in favor of the defendants, followed by 16% (21/135) plaintiff verdicts and 3% (4/135) mixed verdicts. Most procedures performed involved the colon (66%, 129/195). Out of total cases with known complications, most included anastomotic leak (17%, 25/146) and infection/sepsis (16%, 24/146). Death of the patient occurred in 29% (58/201) of cases. No significant differences were found between defendant and plaintiff verdicts for case type, patient sex, and death of patient.
Conclusions:
This study is the most comprehensive review of medico-legal outcomes and associated factors involving colorectal procedures in the United States. Most cases involved general surgeons, with intraoperative complications as the leading cause of suit. Verdicts mostly favored the defendants. Common complications were anastomotic leaks and infection/sepsis. Sub-analysis suggests that patient death does not influence the verdict of a case. Understanding this data has implications for improving clinical practice involving colorectal procedures, which can lead to better healthcare and a reduction in cost associated with malpractice suits.