MONTREAL – When surgeons are sued and lose or settle in cases relating to management of small bowel obstruction, the payout is often costly, according a study involving a close examination of 158 such cases.
The odds of a positive outcome aren’t great. “When looking at award payouts, close to half of cases resulted in a verdict with monetary compensation for the patient,” said Dr. Asad Choudhry, a postdoctoral fellow in the department of trauma, critical care, and surgery at the Mayo Clinic, Rochester, Minn.
Dr. Choudhry, presenting his findings at the annual meeting of the Central Surgical Association, said that general surgeons are the third most likely specialty to be sued, coming only after neurosurgeons and cardiothoracic surgeons. In a given year, about 15% of all general surgeons will be sued, with almost a third of those suits resulting in a payment to the plaintiff. By age 65 years, said Dr. Choudhry, 99% of physicians in higher-risk specialties will face a malpractice claim, compared with 75% of those in lower-risk specialties.
Overall, one-third of malpractice payments come from suits that allege diagnostic error; 24% of suits allege malpractice in surgery. “Small bowel obstruction accounts for 12% to 16% of surgical admissions, with 300,000 operations performed each year,” he said.
Dr. Choudhry and his colleagues searched the Westlaw database using key search terms to identify U.S. malpractice cases that involved small bowel obstruction (SBO), focusing only on cases in which management of SBO was the primary reason for the suit. Cases from 1982 to 2015 were included.
Looking more closely at the 158 cases that resulted from the search, Dr. Choudhry examined variables that included patient demographics, the alleged reason for the malpractice, the settlement or verdict, and the amount paid out, adjusted to 2015 dollars.
In this sample of SBO cases, 139 patients were adults and 19 were children. The median age was 45 years. Over half of the patients in the group died (94/158, 60%), although neither age nor patient death were factors significantly associated with verdict outcome or award amount, he said.
The decade-over-decade growth in the number of suits was striking, increasing 188% during the 1994-2004 period from the previous decade and another 87% from 2005 to 2015.
In a lawsuit involving a SBO, the defendant is more likely to be a general surgeon than to belong to any other specialty. General surgeons were the defendant in 37% of cases, followed by internists in 24% and emergency physicians in 11%.
Dr. Choudhry and his associates conceptually grouped the reasons for the suits into preoperative, intraoperative, and postoperative care. Among the reasons for litigation, by far the most common was untimely intervention in managing of the SBO, a preoperative care component. This was the primary allegation in over 100 of the 158 cases; the next most common reason for bringing suit was incomplete or incorrect surgical procedure, deemed an intraoperative problem and seen in fewer than 20 of the suits.
Almost half of the cases resulted either in a verdict in favor of the plaintiff (n = 37, 23%) or a settlement (n = 36, 23%). When verdicts were returned against the defendant physician, payout amounts varied widely. The smallest amount paid was $29,575 and the largest was over $12 million. Payment amounts were larger with a verdict in favor of the plaintiff, at a median $1,438,800, compared with the median of $1,043,100 received by the plaintiff in a settlement.
Dr. Choudhry noted that early intervention may improve mortality from SBO in some patient groups. “Small bowel obstruction protocols which identify patients at high risk for adverse outcomes and ensure timely management may lessen the chance of litigation,” he said.
Dr. Choudhry acknowledged that the Westlaw database included just a limited amount of medical information. Various tort reform initiatives may have had a confounding effect on award size. It’s possible that using malpractice insurance data could provide more detailed medical information, he said.
Dr. Choudhry reported no relevant disclosures.
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