09.17 Causes and Outcomes of Malpractice Litigation in Gallbladder Surgery: An Evidence-Based Analysis

Posted on September 9, 2020

A. Moro1, A. Farooq1, J. Bae1, D. Rice1, A. Paredes1, D. I. Tsilimigras1, A. L. Crisp2, M. Windholtz2, K. Sahara1, R. Mehta1, L. Wu1, J. Hyer1, E. Parasidis2, T. M. Pawlik1  1Ohio State University,Department Of Surgery,Columbus, OH, USA 2Ohio State University,Moritz College Of Law,Columbus, OH, USA

Introduction:
Cholecystectomy is one of the most commonly performed operations in the United States, yet still carries a 2-5% 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 and Bloomberg Law databases were queried for jury verdicts and settlements related to cholecystectomy and malpractice between 2000-2018. Data were abstracted from the case files and details of the settlements, jury verdicts, and factors related to the claims were assessed. 

Results:
Among the 233 cases, a plaintiff verdict was reached in 48 (21%) and a defendant verdict was reached in 123 (53%); other cases were either settled (n=28, 12%), dismissed (n=30, 13%), or denied (n=4, 2%).  Plaintiff cases most often involved young (median age, 44 years [IQR: 36–57]) female (n=142, 61%) patients. Procedural error (48%), wrongful death (18%), or failure to treat in a timely manner (12%) were the most commonly cited reasons for litigation. Among the 111 patients experiencing a procedural error, the most common intraoperative complications were biliary injury (n=66, 60%) and bowel perforation (n=10, 9%). The total cost of the claims over the study period was $17 M with a median payout of $500,000; the median time from operative event to final disposition was over 5 years (IQR: 4-7). The attending surgeon accounted for 57% of defendants.

Conclusion:
A plaintiff verdict or settlement was reached in 1 in 3 cases and large payouts were common with ligation involving cholecystectomy cases.  Minimizing procedural error and improving care of patients following cholecystectomy associated complications should be emphasized.