Department of Surgery, University of California San Diego, San Diego, CA 92103, USA.
J Am Coll Surg. 2012 Oct;215(4):480-8. doi: 10.1016/j.jamcollsurg.2012.04.028. Epub 2012 Jun 6.
Information about national trends and predictors of malpractice payments can constructively add to the hotly debated topic of medical malpractice. We sought to evaluate predictors of surgical malpractice payments and to explore national trends.
Retrospective analysis of surgery-related malpractice payments using the National Practitioner Data Bank from 1990 to 2006. Payments were adjusted to 2006 dollars. We evaluated predictors of payment size and large payments (defined as those >$1 million). Statutory law in the states demonstrating significant predictive values was analyzed.
In total, 58,518 surgical malpractice payments met inclusion criteria. Patients were predominantly female (62%) and inpatient (63%), with a mean age of 42 years. The number of payments decreased and payment sums increased during the study period. Median payment was $132,915 (95th percentile $983,263). Claims most frequently cited improper performance (42%). Patient outcomes were the strongest predictor of both payment size and likelihood of a large payment. Children younger than 10 years old were 70% more likely to receive a large payment (p = 0.005); and patients older than 70 years were 80% less likely (p < 0.0005). Large variations across states were seen for both payment size and likelihood of large payment. The likelihood of reaching out-of-court settlement did not appear to be correlated with known factors.
Nationwide, surgical malpractice claims show rising payment amounts. Patient outcomes are the strongest predictor of payment size. Considerable variation in payment size between states suggests a profound impact from local legal environments.
有关医疗事故赔偿的国家趋势和预测因素的信息，可以为备受争议的医疗事故话题提供建设性的补充。我们旨在评估外科医疗事故赔偿的预测因素，并探讨国家趋势。
使用国家从业者数据库，对 1990 年至 2006 年期间与外科相关的医疗事故赔偿进行回顾性分析。赔偿金额调整为 2006 年的美元价值。我们评估了赔偿金额大小和大额赔偿（定义为超过 100 万美元）的预测因素。分析了在表现出显著预测价值的州的法定法律。
共有 58518 例外科医疗事故赔偿符合纳入标准。患者主要为女性（62%）和住院患者（63%），平均年龄为 42 岁。在研究期间，赔偿数量减少，赔偿金额增加。中位数赔偿金额为 132915 美元（95%百分位数为 983263 美元）。索赔最常引用的不当表现（42%）。患者的预后是赔偿金额大小和大额赔偿可能性的最强预测因素。10 岁以下的儿童获得大额赔偿的可能性增加 70%（p = 0.005）；70 岁以上的患者获得大额赔偿的可能性降低 80%（p < 0.0005）。各州之间在赔偿金额大小和大额赔偿可能性方面都存在巨大差异。达成庭外和解的可能性似乎与已知因素无关。
在全国范围内，外科医疗事故索赔显示出赔偿金额不断增加的趋势。患者的预后是赔偿金额大小的最强预测因素。各州之间赔偿金额大小的巨大差异表明当地法律环境的影响很大。
