Journal articles: 'Surgical litigation'

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Alderson, Derek. "Surgical experts and litigation." Bulletin of the Royal College of Surgeons of England 100, no. 3 (May 2018): 117. http://dx.doi.org/10.1308/rcsbull.2018.117.

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McLean, T. R., and S. Waxman. "Robotic surgery litigation." Proceedings of the Institution of Mechanical Engineers, Part C: Journal of Mechanical Engineering Science 224, no. 7 (January 12, 2010): 1539–45. http://dx.doi.org/10.1243/09544062jmes1961.

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Like robotic surgery itself, the litigation that follows a robotic surgical misadventure is complex. This complexity is not only a reflection of a product's liability, but also because metadata are contained in surgical robots. Analogous to the ‘black box’ stored on airplanes, at the time of litigation, metadata may be a friend or a foe to the robot's manufacturer. This section provides an overview of the products liability law that can impact a robotic surgical manufacturer and concludes that for most surgical misadventures, a robotic surgical manufacturer will be better off if the surgical instrument stores large volumes of metadata.

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Rich, Barrie S., Kevin Shelton, and Richard D. Glick. "Litigation involving pediatric surgical conditions." Journal of Pediatric Surgery 55, no. 4 (April 2020): 602–8. http://dx.doi.org/10.1016/j.jpedsurg.2019.08.047.

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Mead, John. "Trends in surgical litigation claims." Bulletin of the Royal College of Surgeons of England 96, no. 6 (June 2014): 180–83. http://dx.doi.org/10.1308/147363514x13990346756328.

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Civil claims against NHS bodies in England arising from the actions or inaction of surgeons have risen by 66% in 5 years owing to the funding system in place prior to 1 April 2013. Orthopaedics accounts for the largest percentage of claims. The basic legal test (Bolam) has been in place since the late 1950s and has been amended only slightly by Bolitho in 1997.

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Lane, Jenni, Rahul Bhome, and Bhaskar Somani. "National trends and cost of litigation in UK National Health Service (NHS): a specialty-specific analysis from the past decade." Scottish Medical Journal 66, no. 4 (November 2021): 168–74. http://dx.doi.org/10.1177/00369330211052627.

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Background and aims Medical litigation claim and costs in UK are rising. This study aims to analyse the 10-year trend in litigation costs for individual clinical specialties in the UK from 2009/10 to 2018/19. Methods Data were procured from National Health Service (NHS) Resolution. Number of claims, total litigation costs and cost per claim were ascertained for each financial year. The data collected also includes the number of claims and average amount per claim per speciality during the years 2009–2019 (2009/2010 to 2018/2019 financial years). Results The total annual cost of NHS litigation is currently £3.6 billion(2018/2019). Damages make up the greatest proportion of costs(£1.5 billion). Surgical specialties have the greatest number of claims annually(2847) but Obstetrics has the greatest total litigation(£1.9 billion) and cost per claim(£2.6 million). Number of claims, total costs and cost per claim are significantly greater in 2018/2019 than in 2009/2010. Conclusions Addressing the issue of litigations is complex. Medically there are speciality specific issues that require attention, whilst some general measures are common to all: effective communication, setting realistic targets and maintaining a motivated, adequately staffed workforce. These, alongside legal reforms, may reduce the financial burden of increasing litigation on the NHS.

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Goodwin, H. "Litigation and surgical practice in the UK." British Journal of Surgery 87, no. 8 (August 1, 2000): 977–79. http://dx.doi.org/10.1046/j.1365-2168.2000.01562.x.

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Barthel, Erik R., Bruce E. Stabile, David Plurad, Dennis Kim, Angela Neville, Scott Bricker, Brant Putnam, and Fred Bongard. "Surgical Malpractice in California: Res Judicata." American Surgeon 80, no. 10 (October 2014): 1007–11. http://dx.doi.org/10.1177/000313481408001021.

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Medical negligence claims are of increasing concern to surgeons. Although noneconomic damage awards in California are limited by the Medical Injury Compensation Reform Act (MICRA) law to $250,000, the total amount of such settlements can increase significantly based on claims for economic damages. We reviewed negligence litigation involving California surgeons to determine outcomes and monetary awards through retrospective review of surgical malpractice cases published in a legal journal. This review was limited to actions involving general surgeons. Such litigation was voluntarily reported by either defense's or plaintiff's counsel at the conclusion of the litigation. Data reviewed included alleged damages incurred by the plaintiff; plaintiff's pre-trial settlement demand, plaintiff or defense verdict, use of alternate means of resolution such as arbitration or mediation, and total monetary award to the plaintiff. A total of 69 cases were reported over a 20-month period: 32 (46%) were plaintiffs’ verdicts, whereas 37 (54%) were in favor of the surgeon. Only 10 (31%) of the plaintiff verdicts were by jury trial, whereas the rest were settled by pretrial agreement, mediation, or arbitration. Of cases settled by alternate dispute resolution, the median settlement was $820,000 (n = 22) compared with a median jury trial award of $300,000 (n = 10).

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Mukherjee, S., C. Pringle, and M. Crocker. "A nine-year review of medicolegal claims in neurosurgery." Annals of The Royal College of Surgeons of England 96, no. 4 (May 2014): 266–70. http://dx.doi.org/10.1308/003588414x13814021679834.

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Introduction Neurosurgery remains among the highest malpractice risk specialties. This study aimed to identify areas in neurosurgery associated with litigation, attendant causes and costs. Methods Retrospective analysis was conducted of 42 closed litigation cases treated by neurosurgeons at one hospital between March 2004 and March 2013. Data included clinical event, timing and reason for claim, operative course and legal outcome. Results Twenty-nine claims were defended out of court and twelve were settled out of court. One case required court attendance and was defended. Of the 42 claims, 28, 13 and 1 related to spinal (0.3% of caseload), cranial (0.1% of caseload) and peripheral nerve (0.07% of caseload) surgery respectively. The most common causes of claims were faulty surgical technique (43%), delayed diagnosis/misdiagnosis (17%), lack of information (14%) and delayed treatment (12%), with a likelihood of success of 39%, 29%, 17% and 20% respectively. The highest median payouts were for claims against faulty surgical technique (£230,000) and delayed diagnosis/misdiagnosis (£212,650). The mean delay between clinical event and claim was 664 days. Conclusions Spinal surgery carries the highest litigation risk versus cranial and peripheral nerve surgery. Claims are most commonly against faulty surgical technique and delayed diagnosis/misdiagnosis, which have the highest success rates and payouts. In spinal surgery, the most common cause of claims is faulty surgical technique. In cranial surgery, the most common cause is lack of information. Claims may occur years after the clinical event, necessitating thorough contemporaneous documentation for adequate future defence. We emphasise thorough patient consultation and meticulous surgical technique to minimise litigation in neurosurgical practice.

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Wheeler, R., S. Blackburn, and H. Biggs. "When might an operative complication be regarded as acceptable? Part 1: Surgical factors that influence courts when finding fault during litigation." Annals of The Royal College of Surgeons of England 97, no. 2 (March 2015): 98–101. http://dx.doi.org/10.1308/003588414x14055925060956.

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In cases where surgeons face litigation over operative misadventure, the result of a trial is uncertain. In order to identify factors in cases of surgical litigation that have influenced the final decision of the courts, we have reviewed recent reported cases, noting both surgical and evidential influences on outcome. Taken together, these reveal that among other influential factors, the acceptability of more than one reasonable operative approach, the court’s approach to inappropriate delegation and the uncertainties of expert evidence all play a role in the determination of the case.

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Ellis, Harold. "Medico-legal Litigation and its Links with Surgical Anatomy." Surgery (Oxford) 20, no. 8 (August 2002): i—ii. http://dx.doi.org/10.1383/surg.20.8.0.14518.

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Rich, Barrie, and Richard D. Glick. "Malpractice Litigation Involving Pediatric Surgical Conditions in the US." Journal of the American College of Surgeons 227, no. 4 (October 2018): e191-e192. http://dx.doi.org/10.1016/j.jamcollsurg.2018.08.518.

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Raggio, Blake S., William C. Harris, Ryan D. Winters, and H. D. Graham. "Analysis of Factors Associated With Malpractice Litigation in Rhinoplasty." American Journal of Cosmetic Surgery 36, no. 3 (February 7, 2019): 151–57. http://dx.doi.org/10.1177/0748806819827408.

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Rhinoplasty, the third most common cosmetic surgical procedure in the United States, represents the second most litigated facial plastic surgery procedure. Previous examinations of litigation specific to rhinoplasty are limited. The objective of this study was to comprehensively evaluate rhinoplasty malpractice litigation over the past 30 years and to investigate the financial burden of medical malpractice litigation associated with rhinoplasty, as well as factors that contribute to litigation and negative defendant outcomes. Jury verdict and payment reports related to rhinoplasty malpractice litigations over the past 30 years (1988-2018) were obtained using the WestlawNext and Nexis Uni subscription-based legal databases. The term “malpractice” was searched in combination with “rhinoplasty” and various names associated with the procedure. Cases included in the analysis were reviewed for outcomes, verdict payments, defendant specialty, and allegations raised in proceedings. Of the 46 cases identified, 12 (26%) were resolved with a plaintiff verdict payment. The median payment awarded was $127 500 (standard deviation, $96 590.63). The surgeon specialties found for 35 cases included otolaryngology (17 [49%]), plastic surgery (13 [37%]), facial plastic surgery (3 [9%]), and oral/maxillofacial surgery (OMFS; 2 [6%]). A greater proportion of cases involving otolaryngologists were resolved with payment compared with cases involving plastic surgeons (4 [24%] vs 1 [8%]), though this difference did not reach statistical significance ( P = .26). The most common allegations raised among the 46 cases were poor cosmesis (20 [43%]), intraoperative negligence (18 [39%]), inadequate informed consent (13 [28%]), and nasal function deficits (13 [28%]). Cases had a higher likelihood of being resolved in payment when allegations of cosmetic deformity (7%, 95% confidence interval [CI], −17.55 to 31.91) and nasal function deficit (17%, 95% CI, −9.29 to 45.32) were present, nevertheless these findings did not reach statistical significance ( P = .60 and P = .24, respectively). Rhinoplasty malpractice litigation resulting in payments can create substantial financial burden for the defendant. Common factors cited by plaintiffs for pursuing rhinoplasty malpractice litigation included cosmetic deformity, intraoperative negligence, lack of informed consent, and nasal function deficit. Cosmetic deformity and nasal function deficit allegations tended to result in negative defendant outcomes, though these findings are inconclusive. Our findings reinforce the importance of physician-patient communication, including conducting a comprehensive informed consent process, to limit or avoid postsurgical allegations.

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Wheeler, R., S. Blackburn, and H. Biggs. "When might an operative complication be regarded as acceptable? Part 2: Judicial factors that influence the finding of fault during surgical litigation." Annals of The Royal College of Surgeons of England 97, no. 3 (April 2015): 180–83. http://dx.doi.org/10.1308/003588414x14055925060992.

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In cases where surgeons face litigation over operative misadventure, the result of a trial is uncertain. In order to identify factors in cases of surgical litigation that have influenced the final decision of the courts, we have previously reviewed reported cases where the outcome turned on actions taken by surgeons. We now turn our attention to judicial attitudes to evidence that play a role in the determination of the case.

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Boyke, Andre E., Edward R. Bader, Ishan Naidu, Sharon Lam, Mohammed Ali Alvi, Abigail Funari, and Vijay Agarwal. "Medical malpractice and meningiomas: an analysis of 47 cases." Neurosurgical Focus 49, no. 5 (November 2020): E22. http://dx.doi.org/10.3171/2020.8.focus20598.

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OBJECTIVEAmong medical practices, surgical fields, including neurosurgery, are at a high risk for medical malpractice litigation. With meningiomas contributing to 10% of the total neurosurgery litigation cases, the aim of this study was to identify demographic characteristics, reasons for litigation, and surgical complications commonly reported in these cases. This analysis serves to increase neurosurgeons’ awareness of factors associated with medical malpractice litigation.METHODSThe online legal database Westlaw was utilized to query public litigation cases related to the medical management of meningiomas between December 1985 and May 2020. Variables extracted included the following: plaintiff and defendant demographics, litigation category, plaintiff medical complaints, and trial outcomes. The authors compared these characteristics between cases with decisions in favor of the defendant and those with decisions in favor of the plaintiff.RESULTSA total of 47 cases met the inclusion criteria. Failure to diagnose (68.1%) was the most common type of malpractice claim, and surgical complications (19.1%), motor weakness (33%), and financial loss (33%) were cited as the most common postoperative complaints. Individual specialties that most often required defense due to malpractice claims were radiology (21.7%) and neurosurgery (19.6%). The jury verdict was in favor of the defense in 51.1% of cases and in favor of the plaintiff in 27.7% of cases. A settlement was reached in 19.1% of cases. The mean payout for a verdict in favor of the plaintiff was $3,409,650.22, while the mean payout for settlements was $867,555.56. The greatest average payout for specialties was in neurosurgery at $3,414,400, followed by radiology at $3,192,960. Cases with a verdict in favor of the plaintiff were more likely to involve an internal medicine physician as a defendant (p = 0.007).CONCLUSIONSOver one-half of the cases resulted in a defendant’s verdict with failure to diagnose cited as the most common reason for litigation. Radiology and neurosurgery were the most common specialties for legal cases and also had some of the largest average payouts based on specialty. Motor weakness and financial loss were the most common plaintiff postoperative complaints. These findings may inform surgeons on active measures to take, such as increasing focus on diagnostic accuracy and reducing specific postoperative complaints, such as motor weakness, through risk management and prophylactic measures, to reduce unfavorable legal outcomes.

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Fischer, J. E. "The effect of litigation on surgical practice in the USA." British Journal of Surgery 87, no. 7 (July 2000): 833–34. http://dx.doi.org/10.1046/j.1365-2168.2000.01457.x.

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Morris, Luc G. T., David J. S. Ziff, and Mark D. DeLacure. "Malpractice Litigation After Surgical Injury of the Spinal Accessory Nerve." Archives of Otolaryngology–Head & Neck Surgery 134, no. 1 (January 1, 2008): 102. http://dx.doi.org/10.1001/archotol.134.1.102.

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Berkowitz, Seth, Harry Marshall, and Anthony Charles. "Article Commentary: Retained Intra-abdominal Surgical Instruments: Time to Use Nascent Technology?" American Surgeon 73, no. 11 (November 2007): 1083–85. http://dx.doi.org/10.1177/000313480707301101.

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Retention of surgical instruments is a possible complication of surgery; moreover, its occurrence has typically been used to denote poor surgical care on the part of the individual surgeon and the healthcare system. In the literature, it is not surprising that instances of retained foreign bodies are underreported to minimize exposure to possible litigation.

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Harrison, WD, B. Narayan, AW Newton, JV Banks, and G. Cheung. "Litigation costs of wrong-site surgery and other non-technical errors in orthopaedic operating theatres." Annals of The Royal College of Surgeons of England 97, no. 8 (November 1, 2015): 592–97. http://dx.doi.org/10.1308/rcsann.2015.0045.

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Introduction This study reviews the litigation costs of avoidable errors in orthopaedic operating theatres (OOTs) in England and Wales from 1995 to 2010 using the National Health Service Litigation Authority Database. Materials and methods Litigation specifically against non-technical errors (NTEs) in OOTs and issues regarding obtaining adequate consent was identified and analysed for the year of incident, compensation fee, cost of legal defence, and likelihood of compensation. Results There were 550 claims relating to consent and NTEs in OOTs. Negligence was related to consent (n=126), wrong-site surgery (104), injuries in the OOT (54), foreign body left in situ (54), diathermy and skin-preparation burns (54), operator error (40), incorrect equipment (25), medication errors (15) and tourniquet injuries (10). Mean cost per claim was £40,322. Cumulative cost for all cases was £20 million. Wrong-site surgery was error that elicited the most successful litigation (89% of cases). Litigation relating to implantation of an incorrect prosthesis (eg right-sided prosthesis in a left knee) cost £2.9 million. Prevalence of litigation against NTEs has declined since 2007. Conclusions Improved patient-safety strategies such as the World Health Organization Surgical Checklist may be responsible for the recent reduction in prevalence of litigation for NTEs. However, addition of a specific feature in orthopaedic surgery, an ‘implant time-out’ could translate into a cost benefit for National Health Service hospital trusts and improve patient safety.

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Ross, Sue. "Is Patient Litigation Part of the Regulatory Framework for Surgical Devices?" Journal of Obstetrics and Gynaecology Canada 31, no. 7 (July 2009): 603–4. http://dx.doi.org/10.1016/s1701-2163(16)34238-4.

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Veerman, M. M., L. A. van der Woude, M. A. Tellier, J. Legemaate, M. R. Scheltinga, L. P. S. Stassen, and W. K. G. Leclercq. "A decade of litigation regarding surgical informed consent in the Netherlands." Patient Education and Counseling 102, no. 2 (February 2019): 340–45. http://dx.doi.org/10.1016/j.pec.2018.08.031.

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Daniels, Alan H., Roy Ruttiman, Adam E. M. Eltorai, J. Mason DePasse, Bielinsky A. Brea, and Mark A. Palumbo. "Malpractice litigation following spine surgery." Journal of Neurosurgery: Spine 27, no. 4 (October 2017): 470–75. http://dx.doi.org/10.3171/2016.11.spine16646.

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OBJECTIVEAdverse events related to spine surgery sometimes lead to litigation. Few studies have evaluated the association between spine surgical complications and medical malpractice proceedings, outcomes, and awards. The aim of this study was to identify the most frequent causes of alleged malpractice in spine surgery and to gain insight into patient demographic and clinical characteristics associated with medical negligence litigation.METHODSA search for “spine surgery” spanning February 1988 to May 2015 was conducted utilizing the medicolegal research service VerdictSearch (ALM Media Properties, LLC). Demographic data for the plaintiff and defendant in addition to clinical data for the procedure and legal outcomes were examined. Spinal cord injury, anoxic/hypoxic brain injury, and death were classified as catastrophic complications; all other complications were classified as noncatastrophic. Both chi-square and t-tests were used to evaluate the effect of these variables on case outcomes and awards granted.RESULTSA total of 569 legal cases were examined; 335 cases were excluded due to irrelevance or insufficient information. Of the 234 cases included in this investigation, 54.2% (127 cases) resulted in a defendant ruling, 26.1% (61) in a plaintiff ruling, and 19.6% (46) in a settlement. The awards granted for plaintiff rulings ranged from $134,000 to $38,323,196 (mean $4,045,205 ± $6,804,647). Awards for settlements ranged from $125,000 to $9,000,000 (mean $1,930,278 ± $2,113,593), which was significantly less than plaintiff rulings (p = 0.022). Compared with cases without a delay in diagnosis of the complication, the cases with a diagnostic delay were more likely to result in a plaintiff verdict or settlement (42.9% vs 72.7%, p = 0.007) than a defense verdict, and were more likely to settle out of court (17.5% vs 40.9%, p = 0.008). Similarly, compared with cases without a delay in treatment of the complication, those with a therapeutic delay were more likely to result in a plaintiff verdict or settlement (43.7% vs 68.4%, p = 0.03) than a defense verdict, and were more likely to settle out of court (18.1% vs 36.8%, p = 0.04). Overall, 28% of cases (66/234) involved catastrophic complications. Physicians were more likely to lose cases (plaintiff verdict or settlement) with catastrophic complications (66.7% vs 37.5%, p < 0.001). In cases with a plaintiff ruling, catastrophic complications resulted in significantly larger mean awards than noncatastrophic complications ($6.1M vs $2.9M, p = 0.04). The medical specialty of the provider and the age or sex of the patient were not associated with the case outcome or award granted (p > 0.05). The average time to a decision for defendant verdicts was 5.1 years; for plaintiff rulings, 5.0 years; and for settlements, 3.4 years.CONCLUSIONSDelays in the diagnosis and the treatment of a surgical complication predict legal case outcomes favoring the plaintiff. Catastrophic complications are linked to large sums awarded to the plaintiff and are predictive of rulings against the physician. For physician defendants, the costs of settlements are significantly less than those of losing in court. Although this study provides potentially valuable data from a large series of postoperative litigation cases, it may not provide a true representation of all jurisdictions, each of which has variable malpractice laws and medicolegal environments.

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Vahidi, Nima, Weitao Wang, Thomas Lee, Jared Inman, and Yadranko Ducic. "Medicolegal Aspects of Craniofacial Trauma." Facial Plastic Surgery 35, no. 06 (November 29, 2019): 657–65. http://dx.doi.org/10.1055/s-0039-1700798.

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AbstractCharacterization of complications in facial trauma management is of special interest to practitioners of facial trauma surgery. It is important for facial trauma surgeons to not only understand the standard of care, but also the pitfalls that can expose them to litigation. Litigation within the realm of facial trauma surgery often manifests from issues with poor communication, inadequate informed consent processes, and poor surgical management. In this analysis, we comprehensively examine malpractice litigation in facial trauma surgery, and outline important factors for surgeons to consider in the care of this patient population. It is important for facial trauma surgeons to understand medicolegal issues within their scope of practice. These include principles of informed consent, state regulated statutes of limitation, and Emergency Medical Treatment and Active Labor Act laws. This analysis emphasizes the importance of exercising appropriate patient care, understanding the indications for surgery, and seeking counsel when necessary.

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Haslett, Jack J., Lindsey A. LaBelle, Xiangnan Zhang, J. Mocco, Joshua Bederson, and Christopher P. Kellner. "An analysis of malpractice litigation in the surgical management of carotid artery disease." Journal of Neurosurgery 132, no. 6 (June 2020): 1900–1906. http://dx.doi.org/10.3171/2019.3.jns182934.

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OBJECTIVECarotid artery disease is a common illness that can pose a significant risk if left untreated. Treatment via carotid endarterectomy (CEA) or carotid artery stenting (CAS) can also lead to complications. Given the risk of adverse events related to treating, or failing to treat, carotid artery disease, this is a possible area for litigation. The aim of this review is to provide an overview of the medicolegal factors involved in treating patients suffering carotid artery disease and to compare litigation related to CEA and CAS.METHODSThree large legal databases were used to search for jury verdicts and settlements in cases related to untreated carotid artery disease, CEA, and CAS. Search terms included “endarterectomy,” “medical malpractice,” “carotid,” “stenosis,” “stenting,” “stent,” and combinations of those words. Three types of cases were considered relevant: 1) cases in which the primary allegation was negligence performing a CEA or perioperative care (CEA-related cases); 2) cases in which the primary allegation was negligence performing a CAS or perioperative care (CAS-related cases); and 3) cases in which the plaintiff alleged that a CEA or CAS should have been performed (failure-to-treat [FTT] cases).RESULTSOne hundred fifty-four CEA-related cases, 3 CAS-related cases, and 67 FTT cases were identified. Cases resulted in 133 verdicts for the defense (59%), 64 settlements (29%), and 27 plaintiff verdicts (12%). The average payout in cases that were settled outside of court was $1,097,430 and the average payout in cases that went to trial and resulted in a plaintiff verdict was $2,438,253. Common allegations included a failure to diagnose and treat carotid artery disease in a timely manner, treating with inappropriate indications, procedural error, negligent postprocedural management, and lack of informed consent. Allegations of a failure to timely treat known carotid artery disease were likely to lead to a payout (60% of cases involved a payout). Allegations of procedural error, specifically where the resultant injury was nerve injury, were relatively less likely to lead to a payout (28% of cases involved a payout).CONCLUSIONSBoth diagnosing and treating carotid artery disease has serious medicolegal implications and risks. In cases resulting in a plaintiff verdict, the payouts were significantly higher than cases resolved outside the courtroom. Knowledge of common allegations in diagnosing and treating carotid artery disease as well as performing CEA and CAS may benefit neurosurgeons. The lack of CAS-related litigation suggests these procedures may entail a lower risk of litigation compared to CEA, even accounting for the difference in the frequency of both procedures.

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Raftery, Andrew, and Particia Scowen. "A survey of communication skills teaching at medical school." Bulletin of the Royal College of Surgeons of England 88, no. 3 (March 1, 2006): 84–86. http://dx.doi.org/10.1308/147363506x97649.

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Communication is an essential component of surgical practice. Awareness of its importance is increasing among surgeons due to both the association between litigation and poor communication and recent requirements for obtaining informed consent. The General Medical Council has stated that medical students should have acquired and demonstrated their proficiency in communication by the end of their undergraduate education. Furthermore, communication skills assessment is now a pass/fail component of the intercollegiate MRCS examination of the surgical royal colleges.

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&NA;. "Patients on Workersʼ Comp or in Litigation Have Dismal Surgical Success Rates." Back Letter 12, no. 5 (May 1997): 51. http://dx.doi.org/10.1097/00130561-199705000-00005.

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Marone, Enrico Maria, Luigi Federico Rinaldi, Michele Conti, Stefania Marconi, Ferdinando Auricchio, Andrea Pietrabissa, and Giuseppe Basile. "Three-Dimensional Printed Models Can Help Settle Malpractice Litigation Over Surgical Interventions." Annals of Vascular Surgery 65 (May 2020): e292-e294. http://dx.doi.org/10.1016/j.avsg.2020.01.001.

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Justin, Grant A., and Scott E. Brietzke. "Cleft Lip and Cleft Palate Surgery: Malpractice Litigation Outcomes." Cleft Palate-Craniofacial Journal 54, no. 1 (January 2017): 75–79. http://dx.doi.org/10.1597/15-285.

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Objective This study examined malpractice claims related to cleft lip and cleft palate surgery to identify common allegations and injuries and reviewed financial outcomes. Design The WestlawNext legal database was analyzed for all malpractice lawsuits and settlements related to the surgical repair of cleft lip and palate. Main Outcomes Measures Inclusion criteria included patients undergoing surgical repair of a primary cleft lip or palate or revision for complications of previous surgery. Data evaluated included patient demographics, type of operation performed, plaintiff allegation, nature of injury, and litigation outcomes. Results A total of 36 cases were identified, with 12 unique cases from 1981 to 2006 meeting the inclusion criteria. Six cases (50%) were decided by a jury and six by settlement. Five cases involved complications related to the specific surgery, and the other seven were associated with any surgery and perioperative care of children and adults. Cleft palate repair (50%) was the most frequently litigated surgery. Postoperative negligent supervision was the most common allegation (42%) and resulted in a payout in each case (mean = $3,126,032). Death (42%) and brain injury (25%) were the most frequent injuries reported. Financial awards were made in nine cases (after adjusting for inflation, mean - $2,470,552, range - $0 to $7,704,585). The awards were significantly larger for brain injury than other outcomes ($4,675,395 versus $1,368,131 after adjusting for inflation, P - .0101). Conclusion Malpractice litigation regarding cleft lip and palate surgery is uncommon. However, significant financial awards involving perioperative brain injury have been reported.

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Haslett, J. J., L. A. LaBelle, X. Zhang, J. Mocco, J. Bederson, and C. P. Kellner. "An Analysis of Malpractice Litigation in the Surgical Management of Carotid Artery Disease." Journal of Vascular Surgery 70, no. 4 (October 2019): 1376. http://dx.doi.org/10.1016/j.jvs.2019.07.009.

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Naidoo, Dinesh. "Spontaneous and rapid resolution of a massive lumbar disc herniation." Surgical Neurology International 12 (July 19, 2021): 352. http://dx.doi.org/10.25259/sni_491_2021.

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Background: Most lumbar disc herniations can be successfully treated conservatively. However, massive lumbar disc herniations are often treated surgically to avoid permanent cauda equina syndromes/neurological deficits and potential litigation. Nevertheless, here, we present a 51-year-old female who refused lumbar surgery due to coronavirus disease 2019 (COVID-19) and sustained a full spontaneous recovery without surgical intervention. Case Description: A 51-year-old female presented with a massive lumbar disc herniation at the L5S1 level. Despite refusing surgery for fear of getting COVID-19, she spontaneously neurologically improved without any residual neurological or radiographic sequelae. Conclusion: Although the vast majority of patients with massive lumbar disc herniations are managed surgically, there are rare instances in which nonoperative management may be successful.

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Grimes, Caris E., Belinda Stringer, and Linda Roberts-Jones. "Simple and powerful: a consultant and governance-led bereavement service." BMJ Supportive & Palliative Care 10, no. 2 (January 10, 2019): 224–27. http://dx.doi.org/10.1136/bmjspcare-2018-001661.

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BackgroundFollowing bereavement, families can be left with unanswered questions or issues of concern. We piloted a bereavement service model which was consultant and governance-led with the aim to reduce complaints, reduce litigation, reduce coroners' inquests and support families.MethodsFollowing the death of a patient, the next of kin was sent an invitation. Those that responded were offered a 1-hour appointment with a consultant, senior sister and a member of the governance team. Notes were taken to track themes and feedback sheets were introduced to gauge the usefulness of the service to families.ResultsOf 121 invitations sent out, 18 families (14.8%) used the service. Two families had already sought legal advice. Neither acted further. 44% said they would have made a complaint if the service had not been available. 78% stated that they had obtained closure.ConclusionA bereavement service model which is consultant and governance led may reduce complaints and reduce litigation.

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Sarmiento, Samuel, Charles Wen, Michael A. Cheah, Stacey Lee, and Gedge D. Rosson. "Malpractice Litigation in Plastic Surgery: Can We Identify Patterns?" Aesthetic Surgery Journal 40, no. 6 (September 29, 2019): NP394—NP401. http://dx.doi.org/10.1093/asj/sjz258.

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Abstract Background Malpractice litigation has a significant impact on healthcare costs and important professional implications for healthcare providers. Objectives The authors sought to comprehensively characterize the litigation landscape in plastic surgery across its different subspecialties. Methods The authors utilized the Westlaw legal database to conduct a comprehensive search of malpractice cases in the United States in the following categories: cosmetic, reconstructive, hand, craniofacial, and gender affirmation surgery. They conducted both a Boolean and a natural language search to identify cases in which a plastic surgeon was the defendant. Data were analyzed employing descriptive statistics, logistic regression, and relative risk calculations. Results In total, 165 cases were included. Most surgeons accused of malpractice worked in a private setting (148 [90%]). Among the 22 (13%) cases that contained information on board certification status, most surgeons were board certified (17 [77%]). Resident involvement was mentioned in only 5 (3%) cases. The majority of cases were successfully defended by surgeons (98 [60%] vs 65 [40%]), particularly in craniofacial surgery (risk ratio: 1.54; P = 0.03; 95% CI: 1.03-2.3). Surgeons who successfully defended a case were more likely to benefit from summary judgment (P = 0.005). Conclusions Malpractice litigation is commonplace in medical practice, and no specialty is spared. Legal outcomes were in favor of plastic surgeons in the majority of cases, particularly those that proceeded to summary judgment. Surgeons can avoid litigation by maintaining detailed office and surgical notes, always obtaining informed consent, adequately following and monitoring patients after surgery, and ensuring compliance by communicating frequently and effectively.

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Zoorob, Dani, Mickey Karram, Anna Stecher, Rose Maxwell, and James Whiteside. "Analysis of Surgical Outcomes and Determinants of Litigation Among Women With Transvaginal Mesh Complications." Female Pelvic Medicine & Reconstructive Surgery 22, no. 6 (2016): 404–9. http://dx.doi.org/10.1097/spv.0000000000000304.

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Meshram, Vikas Sukhadeo, Priyatama Vikas Meshram, and Pravin Lambade. "Assessment of Nerve Injuries after Surgical Removal of Mandibular Third Molar: A Prospective Study." Asian Journal of Neuroscience 2013 (November 17, 2013): 1–6. http://dx.doi.org/10.1155/2013/291926.

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Although third molar extraction is a routinely carried out procedure in a dental set-up, yet it is feared both by the patient and the dentist due to an invariable set of complications associated with it, especially in the form of nerve injuries. Hence, prior to performing such procedures, it would be wise if the clinician thoroughly evaluates the case for any anticipated complications so that adequate preventive measures can be taken to minimize the traumatic outcomes of the procedure and provide maximum patient care, which would further save the clinician from any sort of litigation.

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Bhutta, MA, MS Arshad, S. Hassan, and JJ Henderson. "Trends in joint arthroplasty litigation over five years: the British experience." Annals of The Royal College of Surgeons of England 93, no. 6 (September 2011): 460–64. http://dx.doi.org/10.1308/003588411x587226.

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INTRODUCTION Increasing numbers of joint arthroplasty are performed in Britain. While associated complications are well documented, it is not known which of those initiate malpractice claims. METHOD A five-year period was assessed for trends to highlight areas for further improvement in patient information and surgical management. RESULTS The National Health Service paid out almost £14 million for 598 claims. Forty per cent of this was for legal costs. The number of claims increased over time while the rate of successful claims decreased. CONCLUSIONS A failure to consent adequately and to adhere to policies and standard practice can result in a successful malpractice claim. Protecting patients intrao-peratively and maintaining high technical expertise while implementing policies and obtaining informed consent decreases the litigation burden.

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White, Victoria, Alexander Nath, and Gerard Stansby. "Litigation claims relating to venous thromboembolism in the NHS." Phlebology: The Journal of Venous Disease 30, no. 6 (May 28, 2014): 389–96. http://dx.doi.org/10.1177/0268355514537487.

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Aim Litigation costs for clinical negligence in the management of venous thromboembolism have escalated in the last five years. The National Health Service Litigation Authority estimates these claims have cost in excess of £112 million. Our aim is to identify the areas of practice where these claims are most likely to arise to help improve patient outcome. Methods The National Health Service Litigation Authority provided de-identified data on individual medical negligence claims against the NHS since 2007. We subcategorised the data into (a) the nature of the venous thromboembolism event, (b) the area of specialist practice and (c) the damages incurred. Inter-group differences were evaluated using ANOVA, Kruskal–Wallis test and Mann–Whitney U Test. Results Failure to prevent and to diagnose pulmonary emboli and deep vein thrombosis occurs across the spectrum of clinical specialties. In the study period 189 claims were made. The majority of claims were in surgical specialties and the financial burden was significantly greater than in the medical specialities (£3,257,394 vs. £1,532,996). The amounts paid out by specialty was not significantly different but had significant variance ( p < 0.0001). Conclusions The National Institute of Clinical Excellence provides comprehensive guidelines on venous thromboembolism risk assessment. Poor compliance has contributed to morbidity and mortality while the cost has continued to escalate. A multimodal approach to education is needed to improve patient outcome. Improved venous thromboembolism prevalence data are also needed.

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Choudhry, Asad J., Nadeem N. Haddad, Mohammad A. Khasawneh, Daniel C. Cullinane, and Martin D. Zielinski. "Surgical Fires and Operative Burns: Lessons Learned From a 33-Year Review of Medical Litigation." American Journal of Surgery 213, no. 3 (March 2017): 558–64. http://dx.doi.org/10.1016/j.amjsurg.2016.12.006.

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Rainsbury, Dick. "The Eagle Project – something for everyone." Bulletin of the Royal College of Surgeons of England 89, no. 6 (June 1, 2007): 194–95. http://dx.doi.org/10.1308/147363507x204567.

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Real progress is being made with the Eagle Project – the multimillion-pound scheme to convert the education facilities on the fourth floor of the College. The recent highly successful College conference Anatomy Teaching – the Cruellest Cut of All (see page 194), reconfirmed the central importance of the Eagle Project in teaching surgical anatomy and in maintaining high standards in surgical practice. The conference highlighted the stark and worrying effects of a changing undergraduate curriculum on levels of basic anatomical knowledge. This in turn impacts on postgraduate examination results and on levels of litigation in the NHS. The capacity and diversity of the Eagle Project's facilities provide the College with a unique resource to tackle these problems at every level – undergraduate, postgraduate and consultant.

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Rafter, Daniel, Ranveer Vasdev, Duncan Hurrelbrink, Mark Gormley, Tabitha Chettupally, Francis X. Shen, and Uzma Samadani. "Litigation risks despite guideline adherence for acute spinal cord injury: time is spine." Neurosurgical Focus 49, no. 5 (November 2020): E17. http://dx.doi.org/10.3171/2020.8.focus20607.

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OBJECTIVECurrent guidelines do not specify timing for management of acute spinal cord injury (aSCI) due to lack of high-quality evidence supporting specific intervals for intervention. Randomized prospective trials may be unethical. Nonetheless, physicians have been sued for delays in diagnosis and intervention.METHODSThe authors reviewed both the medical literature supporting the guidelines and the legal cases reported in the Westlaw and Lexis Advance databases from 1972 to 2018 resulting in awards or settlements, to identify whether surgeons are vulnerable to litigation despite the existence of guidelines not mandating specific timing of care.RESULTSTiming of intervention was related to claims in 59 (36%) of 163 cases involving SCI. All 22 trauma cases identified cited timing of intervention, sometimes related to delayed diagnosis, as a reason for the lawsuit. The mean award of 10 cases in which the plaintiffs’ awards were disclosed was $4,294,384. In the majority of cases, award amounts were not disclosed.CONCLUSIONSBecause conduct of a prospective, randomized trial to investigate surgical timing of intervention for aSCI may not be achievable, evidence-based guidelines will be unlikely to mandate specific timing. Nonetheless, surgeons who unreasonably delay intervention for aSCI may be at risk for litigation due to treatment delay. This is increasingly likely in an environment where “complete” SCI is difficult to verify. SCI may at some point be recognized as a surgical emergency, as brain injury generally is, despite a lack of prospective randomized trials supporting this implementation, challenging the feasibility of the US trauma infrastructure to provide care for these patients.

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Varley, R., C. Lo, and B. Alkhaffaf. "Litigation claims following laparoscopic and open inguinal hernia repairs." Hernia 24, no. 5 (March 30, 2020): 1113–20. http://dx.doi.org/10.1007/s10029-020-02173-y.

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Abstract Purpose Groin hernia repair is the most frequently performed general surgical operation in the UK. Complications from laparoscopic and open repair are well recognised; however, potential differences are yet to be considered in relation to litigation. Methods Administrative data were obtained and analysed from the NHS Litigation Authority for inguinal hernia-related claims from 1995 to 2016. Claims identified as using an open or laparoscopic approach were compared. Results 880 claims were made, 760 had been settled. 88 laparoscopic and 241 open procedures were identified; 65% laparoscopic and 63% open hernia claims were found to be in favour of the claimant. Payouts totalled to 4.1GBP/4.8EUR/5.3USD million and 9.4GBP/11.0EUR/12.1USD million for laparoscopic (mean 82,824GBP/96,579EUR/106,453USD) and open (mean 66,796GBP/77,892EUR/85,852USD) approaches, respectively. The most common reasons for claim initiation were visceral/vascular injury (54%) in the laparoscopic group, and testicular complications or chronic pain (35%) in the open group. Additional procedures were necessary for 48% and 44% of laparoscopic and open claims, respectively. The highest average payouts were associated with visceral injury, (laparoscopic 116,482GBP/135,820EUR/149,715USD; open 199,103GBP/232,246EUR/255,905USD) and vascular injury (laparoscopic 88,624GBP/103,369EUR/113,892USD; open 64,460GBP/75,163EUR/82,870USD). Additional procedures resulted in an average payout of 93,352GBP/108,917EUR/120,008USD (laparoscopic) and 60,408GBP/70,506EUR/77,657USD (open). The most common additional procedures were corrective visceral/vascular repairs, orchidectomy and recurrent hernia repair. Conclusions The rate of litigation for clinical negligence in inguinal hernia surgery in the UK is increasing. Whilst there has been a recent increase in laparoscopic hernia repair claims, the volume and burden of claims related to open procedures remain greater.

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Goodman, Marla J., David Sheuerman, and Stuart B. Goodman. "Litigation Involving Hip and Knee Arthroplasty in the State of California." Open Orthopaedics Journal 13, no. 1 (December 31, 2019): 276–79. http://dx.doi.org/10.2174/1874325001913010276.

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Background: Total hip and knee arthroplasties are generally very successful surgical procedures; however, if there is a complication or if the patient is dissatisfied with the outcome, the patient may initiate a legal suit against the surgeon. Methods and Results: We evaluated the reasons for instigating a legal suit after hip or knee arthroplasty surgery in the State of California between 1981 and 2018. Using a verified database and the keywords hip, knee, replacement, arthroplasty, we identified 12 legal suits filed and adjudicated on during this time period. Of the 12 cases, the major complaints were pain (seven cases), foot drop (three cases) numbness (two cases), foreign item left in the body of the patient (one case), general physical problems (one case), and wrongful death (one case). In some cases, more than one reason was listed (note: the total is greater than 12 because some cases had more than one reason listed). Conclusion: In reviewing these cases and the literature on this subject, we conclude that in order to avoid legal suits, doctors should be communicative, honest, and compassionate with patients, be highly competent in their specialty, and maintain meticulous medical record documentation.

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Ford, Kathryn E., and Lilli R. L. Cooper. "Learning from lawsuits: Ten-years of NHS litigation authority claims against 11 surgical specialities in England." Surgeon 16, no. 1 (February 2018): 27–35. http://dx.doi.org/10.1016/j.surge.2016.03.009.

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Petrucci, Emiliano, Alessandro Vittori, Marco Cascella, Alessandro Vergallo, Gilberto Fiore, Antonio Luciani, Barbara Pizzi, Giulia Degan, Vittorio Fineschi, and Franco Marinangeli. "Litigation in Anesthesia and Intensive Care Units: An Italian Retrospective Study." Healthcare 9, no. 8 (August 7, 2021): 1012. http://dx.doi.org/10.3390/healthcare9081012.

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Anesthesiologists consider professional insurance and its medico-legal problems as a remarkable aspect of their job. “Associazione Anestesisti Rianimatori Ospedalieri Italiani—Emergenza ed Area Critica” (AAROI-EMAC) is the Italian professional association of anesthesiologists and intensivists that works to train its subscribers on safety measures. This is a retrospective observational study on an insurance complaints database for anesthetic accidents that result in injuries to patients. The analyzed period runs from 1 January 2014 to 31 December 2016. A total of 1309 complaints related to 873 insurance claims were analyzed. Criminal complaints comprised 805 (64.4%) of the total, and civil complaints were 445 (35.6%). The iatrogenic damage claimed included: death (58% of the cases); peripheral nerve damage (8%); spinal cord injuries (5%); unspecified injuries (7%); dental damage (4%); infections (3%); needing second surgical procedure (2%); and other injuries (13%). There is a statistical significance between the size of the hospital and the number of the claims: small hospital complaints comprised 40.1% of the cases, while complaints against medium-sized and large hospitals constituted 20.6% of the cases (χ2GL = 8 = 39.87, p = 0.00). In Italy, anesthesiologists and intensivists are often involved in litigation even when they are not directly responsible for iatrogenic injuries, and the most frequent claims in ICU are related post-operative complications.

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Agrawal, Neeraj K. "Strategies to prevent extinction of plastic surgery." International Surgery Journal 7, no. 12 (November 27, 2020): 4252. http://dx.doi.org/10.18203/2349-2902.isj20205397.

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“What we need is not the will to believe, but the wish to find out.” William WordsworthPlastic surgery is a rare combination of carpentry and aesthetics. These skills are so judgmental that the perception of the ideal form varies radically between the surgeons. Plastic surgery being surface surgery is unique as the results are obvious and almost instantaneous. Younger surgeons usually face difficulties in satisfying the patients because of the visibility of surgical results. Litigation and compensation issues may also dissuade medical students to join the revered specialty. Many other issues related to the specialty merit due attention.

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Maciunas, Robert J., and Burton M. Onofrio. "The long-term results of chymopapain chemonucleolysis for lumbar disc disease." Journal of Neurosurgery 65, no. 1 (July 1986): 1–8. http://dx.doi.org/10.3171/jns.1986.65.1.0001.

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✓ The long-term clinical outcome is evaluated for 268 patients after chymopapain chemonucleolysis for radicular complaints referrable to documented intervertebral disc disease. The follow-up period for 92% of these patients was 10 years. No complications due to chymopapain toxicity were observed; 80.1% of patients were relieved of their presenting radicular leg pain and 75.1% were employed at a capacity equal to or more strenuous than before injection. Chemonucleolysis was demonstrated to be a safe and effective treatment modality, with long-term results that compare favorably with those of similarly selected patients undergoing open surgical procedures. In the patients whose chymopapain therapy failed, the outcome of subsequent open surgical procedures was not necessarily compromised by prior chemonucleolysis. A higher rate of failure and subsequent surgical intervention was seen in those patients with injections performed soon after an unsuccessful open procedure on the same side and at the same interspace, those with workmen's compensation or litigation pending, those with a history of work-related injury, those whose employment involved heavy manual labor or extensive driving, and those whose preinjection spine x-ray films indicated retrograde spondylolisthesis.

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Cirocchi, Roberto, Laura Panata, Ewen A. Griffiths, Giovanni D. Tebala, Massimo Lancia, Piergiorgio Fedeli, Augusto Lauro, et al. "Injuries during Laparoscopic Cholecystectomy: A Scoping Review of the Claims and Civil Action Judgements." Journal of Clinical Medicine 10, no. 22 (November 10, 2021): 5238. http://dx.doi.org/10.3390/jcm10225238.

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Background. To define what type of injuries are more frequently related to medicolegal claims and civil action judgments. Methods. We performed a scoping review on 14 studies and 2406 patients, analyzing medicolegal claims related to laparoscopic cholecystectomy injuries. We have focalized on three phases associated with claims: phase of care, location of injuries, type of injuries. Results. The most common phase of care associated with litigation was the improper intraoperative surgical performance (47.6% ± 28.3%), related to a “poor” visualization, and the improper post-operative management (29.3% ± 31.6%). The highest rate of defense verdicts was reported for the improper post-operative management of the injury (69.3% ± 23%). A lower rate was reported in the incorrect presurgical assessment (39.7% ± 24.4%) and in the improper intraoperative surgical performance (21.39% ± 21.09%). A defense verdict was more common in cystic duct injuries (100%), lower in hepatic bile duct (42.9%) and common bile duct (10%) injuries. Conclusions. During laparoscopic cholecystectomy, the most common cause of claims, associated with lower rate of defense verdict, was the improper intraoperative surgical performance. The decision to take legal action was determined often for poor communication after the original incident.

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Deann-Valentine, Yvette. "Risk Assessment in the Post Anaesthetic Care Unit Using Critical Incident Analysis." British Journal of Anaesthetic and Recovery Nursing 3, no. 4 (November 2002): 3–7. http://dx.doi.org/10.1017/s1742645600001649.

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It is generally accepted that the theatre is a highly technical and complex environment where clinical risks need to be managed effectively to ensure safe practice and to limit liability and litigation. Although anaesthesia and post anaesthesia care has long been the focus of risk management, the potential for errors and adverse events remains high. When errors occur, it is important to analyse the causes, so that preventative measures can be taken and similar incidents do not reoccur. This article sets out to examine and evaluate the process of reflection using a critical incident approach. A model of reflective practice, as suggested by Johns [1996] has been used to structure this paper. A critical incident is described and key issues arising from it are discussed and reflected upon. This incident was chosen because important clinical and risk management issues were highlighted.

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Zhang, Jie, Zihui Cheng, Lingjie Kong, Liang Wang, Ze Liu, Long Yu, and Songyue He. "Study on Litigation-expertise of Sudden Pulmonary Embolism for Laparoscopic Inguinal Hernia — Case Report and Literature Review." Journal of Clinical Medicine Research 3, no. 2 (May 23, 2022): 34. http://dx.doi.org/10.32629/jcmr.v3i2.815.

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With the development of new concepts and technologies of laparoscopic diagnosis and treatment, inguinal hernia repair is increasingly and widely used in clinical practice, and accordingly, the corresponding complications of deep vein thrombosis have also attracted clinical attention. Deep-venous thrombosis and pulmonary embolism have become one of the potential and very dangerous serious complications in patients with inguinal hernia. One case of sudden pulmonary embolism shortly after the laparoscopic inguinal hernia repair was reported in this paper, the patient has been trapped in a persistent plant survival state after rescue. The patient was a male, 67-year-old patient with up to 4 hours of operation, and no available clinical evidences about operative vascular injury have been found, however, this case have been triggered a civil lawsuit for medical damages and the filing of a judicial expertise. Combined with the disputes of this case and the results of the technical review, the legal related preoperative notification and informed consent, the requirements and functions of working system before operation, the preoperative examination and the related surgical risk-factors of pulmonary embolism are discussed. It is suggests that the preoperative discussion, preoperative examination and preoperative notification of laparoscopic inguinal hernia should be paid great attention to in clinical work, and form an institutionalized and normative workflow, which plays an important role in effectively controlling the operation time, reducing surgical complications and avoiding medical disputes.

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Shaw, Gary Y., and Elizabeth Pierce. "Malpractice Litigation Involving Iatrogenic Surgical Vocal Fold Paralysis: A Closed-Claims Review with Recommendations for Prevention and Management." Annals of Otology, Rhinology & Laryngology 118, no. 1 (January 2009): 6–12. http://dx.doi.org/10.1177/000348940911800102.

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Burchiel, Kim J., Timothy J. Johans, and Jose Ochoa. "The surgical treatment of painful traumatic neuromas." Journal of Neurosurgery 78, no. 5 (May 1993): 714–19. http://dx.doi.org/10.3171/jns.1993.78.5.0714.

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✓ Pain following suspected nerve injury was comprehensively evaluated with detailed examination including history', neurological evaluation, electrodiagnostic studies, quantitative sensory testing, thermography, anesthetic agents, and sympathetic nerve blocks. Forty-two surgically treated patients fell into four discrete groups: Group 1 patients had distal sensory neuromas treated by excision of the neuroma and reimplantation of the proximal nerve into muscle or bone marrow; Group 2 patients had suspected distal sensory neuromas in which the involved nerve was sectioned proximal to the injury site and reimplanted; Group 3 patients had proximal in-continuity neuromas of major sensorimotor nerves treated by external neurolysis; and Group 4 patients had proximal major sensorimotor nerve injuries at points of anatomical entrapment treated by external neurolysis and transposition, if possible. Patient follow-up monitoring from 2 to 32 months (average 11 months) was possible in 40 (95%) of 42 patients. Surgical success was defined as 50% or greater improvement in pain using the Visual Analog Scale or pain relief subjectively rated as either good or excellent, without postoperative narcotic usage. Overall, 16 (40%) of 40 patients met those criteria. Success rates varied as follows: 44% in 18 Group 1 patients, 40% in 10 Group 2 patients, 0% in five Group 3 patients, and 57% in seven Group 4 patients. Twelve (30%) of 40 patients were employed both pre- and postoperatively. It is concluded that: 1) neuroma excision, neurectomy, and nerve release for injury-related pain of peripheral nerve origin yield substantial subjective improvement in a minority of patients; 2) external neurolysis of proximal mixed nerves is ineffective in relieving pain; 3) surgically proving the existence of a neuroma with confirmed excision may be preferable; 4) traumatic neuroma pain is only partly due to a peripheral source; 5) demographic and neurological variables do not predict success; 6) the presence of a discrete nerve syndrome and mechanical hyperalgesia modestly predict pain relief; 7) ongoing litigation is the strongest predictor of failure; and 8) change in work status is not a likely outcome.

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Franceskides, Constantinos, Thibault Leger, Ian Horsfall, Gianluca Tozzi, Michael Gibson, and Peter Zioupos. "Evaluation of bone excision effects on a human skull model – I: Mechanical testing and digital image correlation." Proceedings of the Institution of Mechanical Engineers, Part H: Journal of Engineering in Medicine 234, no. 4 (December 6, 2019): 337–45. http://dx.doi.org/10.1177/0954411919891885.

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The mechanisms of skull impact loading may change following surgical interventions such as the removal of bone lesions, but little is known about the consequences in the event of subsequent head trauma. We, therefore, prepared acrylonitrile butadiene styrene human skull models based on clinical computed tomography skull data using a three-dimensional printer. Six replicate physical skull models were tested, three with bone excisions and three without. A drop tower was used to simulate the impact sustained by falling backwards onto the occipital lobe region. The impacts were recorded with a high-speed camera, and the occipital strain response was determined by digital image correlation. Although the hole affected neither the magnitude nor the sequence of the fracture pattern, the digital image correlation analysis highlighted an increase in strain around the excised area (0.45%–16.4% of the principal strain). Our approach provides a novel method that could improve the quality of life for patients on many fronts, including protection against trauma, surgical advice, post-operative care, advice in litigation cases, as well as facilitating general biomechanical research in the area of trauma injuries.

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Journal articles on the topic 'Surgical litigation'

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