Cottam Daniel, Lord Jeffrey, Dallal Ramsey M, Wolfe Bruce, Higa Kelvin, McCauley Kathleen, Schauer Philip
Surgical Weight Control Center, Las Vegas, Nevada, USA.
Surg Obes Relat Dis. 2007 Jan-Feb;3(1):60-6; discussion 66-7. doi: 10.1016/j.soard.2006.10.008. Epub 2006 Dec 27.
Very few studies have addressed malpractice litigation specific to bariatric surgery. This study was designed to analyze litigation trends in bariatric surgery to prevent further lawsuits and improve patient care.
A total of 100 consecutive bariatric lawsuits were reviewed by a consortium of experienced bariatric surgeons and an attorney specializing in medical malpractice.
Of the 100 lawsuits, 45% were reviewed for defense attorneys. The mean patient age was 40 years (range 18-65), 75% were women, 81% had a body mass index of <60, 31% were diabetic, and 38% had sleep apnea. Of the surgeons, 42% had <1 year of experience, and 26% had done <100 cases. Although 69% of the physicians were members of the American Society of Bariatric Surgery, only 22% had detailed consent forms. The surgical procedures were performed between 1997 and 2005 and included Roux-en-Y gastric bypass (78% total, 33% open, and 45% laparoscopic), vertical banded gastroplasty (3%), minigastric bypass (6%), biliopancreatic diversion/duodenal switch (4%), and revision (9%). Of the 100 cases, 32% involved an intraoperative complication and 72% required additional surgery. The most common adverse events initiating litigation were leaks (53%), intra-abdominal abscess (33%), bowel obstruction (18%), major airway events (10%), organ injury (10%), and pulmonary embolism (8%). From these injuries, 53 patients died, 28% had a full recovery, 12% had a minor disability, and 7% had major disabilities. Evidence of potential negligence was found in 28% of cases. Of these cases, 82% resulted from a delay in diagnosis and 64% from misinterpreted vital signs.
This study found that leaks and delayed diagnosis were the most common cause of litigation. Even experienced bariatric surgeons should understand the most common errors made by others to prevent complications and avoid litigation.
极少有研究涉及肥胖症手术特有的医疗事故诉讼。本研究旨在分析肥胖症手术的诉讼趋势，以防止进一步的诉讼并改善患者护理。
由经验丰富的肥胖症外科医生和一名专门处理医疗事故的律师组成的团队对总共100起连续的肥胖症诉讼进行了审查。
在这100起诉讼中，45%是由辩护律师审查的。患者的平均年龄为40岁（范围18 - 65岁），75%为女性，81%的体重指数<60，31%患有糖尿病，38%患有睡眠呼吸暂停。在外科医生中，42%的经验不足1年，26%的手术量不足100例。尽管69%的医生是美国肥胖症外科学会的成员，但只有22%有详细的知情同意书。手术在1997年至2005年期间进行，包括Roux-en-Y胃旁路术（总计78%，其中33%为开放手术，45%为腹腔镜手术）、垂直束带胃成形术（3%）、迷你胃旁路术（6%）、胆胰分流/十二指肠转位术（4%）以及翻修手术（9%）。在这100例病例中，32%涉及术中并发症，72%需要再次手术。引发诉讼的最常见不良事件是渗漏（53%）、腹腔内脓肿（33%）、肠梗阻（18%）、重大气道事件（10%）、器官损伤（10%）和肺栓塞（8%）。在这些损伤中，53名患者死亡，28%完全康复，12%有轻度残疾，7%有重度残疾。28%的病例中发现了潜在过失的证据。在这些病例中，82%是由于诊断延误，64%是由于生命体征解读错误。
本研究发现渗漏和诊断延误是诉讼的最常见原因。即使是经验丰富的肥胖症外科医生也应该了解其他人所犯的最常见错误，以预防并发症并避免诉讼。
