Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
Edward P. Lawrence Center for Quality and Safety, Massachusetts General Hospital, Boston, MA.
Ann Surg. 2019 May;269(5):785-791. doi: 10.1097/SLA.0000000000003155.
We aimed to study the contributing factors and costs of malpractice claims involving the surgical management of benign biliary disease given the emotional, physical, and financial toll of these claims on patients, providers, and the healthcare system.
Cholecystectomy complications carry significant morbidity and rank among the leading sources of surgical malpractice claims.
Using the CRICO Strategies' Comparative Benchmarking System database, representing approximately 30% of all paid and unpaid malpractice claims in the United States, 4081 closed claims filed against general surgeons from 1995 to 2015 were reviewed to isolate 745 cholecystectomy-related claims. A multivariable model was used to determine factors associated with claim outcome.
The most common associated complications included bile duct injury (n = 397), bowel perforation (n = 96), and hemorrhage (n = 78). Bile duct injuries were recognized intraoperatively only 19% of the time and required biliary reconstruction surgery 77% of the time. The total cost for all claims over the study period was over $128 M and the median time from event to case close was over 3 years. 40% of claims resulted in patient payout; of these, most claims were settled out of court and the median cost per claim was $264,650. For the 60% of claims not resulting in patient payout, most cases were denied, dropped, or dismissed, yet still averaged over $15,000 per claim in legal and administrative fees. On multivariable analysis, bile duct injury, bowel perforation, and high clinical severity were associated with patient payout, while a resident or fellow being named in a claim was negatively associated with patient payout (P < 0.05).
Cholecystectomy-related claims are costly and time-consuming. Strategies that reduce the risk and aid in recognition of cholecystectomy complications, as well as advance support of patients and families after poor outcomes, may improve clinical care and reduce claim burden.
鉴于医疗纠纷索赔给患者、医疗服务提供者和医疗体系带来的情感、身体和经济上的损失，我们旨在研究涉及良性胆道疾病手术治疗的医疗事故索赔的相关因素和费用。
胆囊切除术的并发症会导致严重的发病率，是导致外科医疗事故索赔的主要原因之一。
使用 CRICO 策略的比较基准系统数据库，该数据库代表美国所有已支付和未支付的医疗事故索赔的约 30%，对 1995 年至 2015 年期间针对普通外科医生提出的 4081 项已结案的索赔进行了审查，以确定 745 项与胆囊切除术相关的索赔。使用多变量模型确定与索赔结果相关的因素。
最常见的相关并发症包括胆管损伤（n=397）、肠穿孔（n=96）和出血（n=78）。胆管损伤仅在 19%的时间内被术中识别，且 77%的时间需要胆管重建手术。研究期间所有索赔的总成本超过 1.28 亿美元，从事件到案件结案的中位数时间超过 3 年。40%的索赔导致患者支付赔偿金；其中，大多数索赔都是庭外和解，每个索赔的平均费用为 264650 美元。对于 60%的未导致患者支付赔偿金的索赔，大多数案件被拒绝、撤销或驳回，但仍平均每个案件的法律和管理费用超过 15000 美元。多变量分析显示，胆管损伤、肠穿孔和高临床严重程度与患者支付赔偿金相关，而索赔中提到住院医师或研究员与患者支付赔偿金呈负相关（P<0.05）。
与胆囊切除术相关的索赔既昂贵又耗时。减少胆囊切除术并发症风险和帮助识别并发症的策略，以及在不良结果发生后为患者和家属提供支持，可能会改善临床护理并减少索赔负担。
