Phair John, Denesopolis John, Lipsitz Evan C, Scher Larry
Montefiore Medical Center, Bronx, NY.
Montefiore Medical Center, Bronx, NY.
Ann Vasc Surg. 2018 Jul;50:15-20. doi: 10.1016/j.avsg.2018.01.093. Epub 2018 Mar 8.
The aim of this study was to analyze malpractice litigation trends and to better understand the causes and outcomes of suits involving inferior vena cava filters (IVCF) to prevent future litigation and improve physician education.
Jury verdict reviews from the Westlaw database from January 1, 2000, to December 31, 2015, were reviewed. The search term "inferior vena cava filter" was used to compile data on the demographics of the defendant, plaintiff, allegation, complication, and verdict.
A total of 156 cases were identified. Duplicates and cases in which the IVCF was incidentally included were excluded from the analysis. Forty-nine cases involving either failure to place or a complication of IVCF placement were identified. Throughout the last 15 years, there has been increased number of jury verdicts toward IVCF. The most frequent defendants were internal medicine physicians (38%), vascular surgeons (19%), and cardiothoracic surgeons (12%). The most frequent claims were denied treatment or delay in treatment (in 35% of cases), negligent surgery (in 24% of cases), and failure to diagnose and treat complications (in 24% of cases). Of these, the most frequent specific claims were failure to place IVC filter (41%), implantation failure such as misplacement and/or misaligned implant (24%), erosion of IVC/retroperitoneal bleed (6%), and discontinuation of anticoagulation prematurely (6%). Seventeen cases (35%) were found for the plaintiff, with median awards worth of $1,092,500. In the 21 cases where pulmonary embolism (PE) was involved (43% of cases), 19 were fatal (90%). Of the fatal PE cases, 8 cases ended with verdicts in favor of the plaintiff (42%). Both nonfatal PE cases were won by the defense.
IVCF placement with subsequent PE and death results in verdicts that favor the plaintiffs. This study emphasizes that adequate and transparent communication regarding preoperative planning, decision for IVCF placement, and informed consent may reduce the frequency of litigation. Public awareness of complications related to the placement of IVCF is increasing largely and spurned by aggressive advertising and marketing by plaintiff attorneys. Conditions for which IVCF placement is contemplated carry significant risk of malpractice litigation.
本研究旨在分析医疗事故诉讼趋势，更好地了解涉及下腔静脉滤器（IVCF）的诉讼原因及结果，以预防未来的诉讼并改进医生教育。
回顾了2000年1月1日至2015年12月31日来自Westlaw数据库的陪审团裁决审查。使用搜索词“下腔静脉滤器”来收集关于被告、原告、指控、并发症和裁决的人口统计学数据。
共识别出156例病例。分析中排除了重复病例和IVCF被偶然提及的病例。确定了49例涉及IVCF放置失败或放置并发症的病例。在过去15年中，针对IVCF的陪审团裁决数量有所增加。最常见的被告是内科医生（38%）、血管外科医生（19%）和心胸外科医生（12%）。最常见的索赔是拒绝治疗或治疗延迟（35%的病例）、手术过失（24%的病例）以及未能诊断和治疗并发症（24%的病例）。其中，最常见的具体索赔是未放置IVC滤器（41%）、植入失败如放置错误和/或植入物未对准（24%）、IVC侵蚀/腹膜后出血（6%）以及过早停止抗凝（6%）。17例（35%）案件判定原告胜诉，赔偿金额中位数为1,092,500美元。在涉及肺栓塞（PE）的21例案件（43%的病例）中，19例是致命的（90%）。在致命的PE病例中，8例以有利于原告的裁决告终（42%）。两例非致命的PE病例均由被告胜诉。
IVCF放置后发生PE并导致死亡的情况会做出有利于原告的裁决。本研究强调，关于术前规划、IVCF放置决策和知情同意的充分且透明的沟通可能会减少诉讼频率。公众对与IVCF放置相关并发症的认识在很大程度上因原告律师的积极广告和营销而提高。考虑放置IVCF的情况存在重大医疗事故诉讼风险。
