Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Lawrence Center for Quality and Safety, Massachusetts General Hospital, Massachusetts General Physicians Organization, Boston, MA, USA.
World J Surg. 2019 Nov;43(11):2850-2855. doi: 10.1007/s00268-019-05102-y.
Given their profound emotional, physical, and financial toll on patients and surgeons, we studied the characteristics, costs, and contributing factors of thyroid and parathyroid surgical malpractice claims.
Using the Controlled Risk Insurance Company Strategies' Comparative Benchmarking System database, representing ~30% of all US paid and unpaid malpractice claims, 5384 claims filed against general surgeons and otolaryngologists from 1995-2015 were reviewed to isolate claims involving the surgical management of thyroid and parathyroid disease. These claims were studied, and multivariable regression analysis was performed to identify factors associated with plaintiff payout.
One hundred twenty-eight thyroid and parathyroid surgical malpractice claims were isolated. The median time from alleged harm event to closure of a malpractice case was 39 months. The most common associated complications were bilateral recurrent laryngeal nerve (RLN) injury (n = 23) and hematoma (n = 18). Complications led to death in 18 cases. Patient payout occurred in 33% of claims (n = 42), and the median cost per claim was $277,913 (IQR $87,343-$783,663). On multivariable analysis, bilateral RLN injury was predictive of patient payout (OR 3.58, p = 0.03), while procedure, death, and surgeon specialty were not.
Though rare, malpractice claims related to thyroid and parathyroid surgery are costly, time-consuming, and reveal opportunities for early surgeon-patient resolution after poor outcomes.
鉴于甲状腺和甲状旁腺手术医疗事故对患者和外科医生在情感、身体和经济方面造成的巨大影响，我们研究了甲状腺和甲状旁腺手术医疗事故索赔的特点、成本和促成因素。
利用控险公司策略比较基准系统数据库（代表了美国约 30%的已支付和未支付医疗事故索赔），对 1995 年至 2015 年间针对普通外科医生和耳鼻喉科医生的 5384 份索赔进行了审查，以确定涉及甲状腺和甲状旁腺疾病手术管理的索赔。对这些索赔进行了研究，并进行了多变量回归分析，以确定与原告赔付相关的因素。
共分离出 128 例甲状腺和甲状旁腺手术医疗事故索赔。从所谓的伤害事件到医疗事故案件结案的中位数时间为 39 个月。最常见的相关并发症是双侧喉返神经（RLN）损伤（n=23）和血肿（n=18）。并发症导致 18 例死亡。33%的索赔（n=42）发生了患者赔付，每个索赔的中位数成本为 277913 美元（IQR 87343-783663）。多变量分析显示，双侧 RLN 损伤与患者赔付相关（OR 3.58，p=0.03），而手术、死亡和外科医生专业则没有。
尽管罕见，但与甲状腺和甲状旁腺手术相关的医疗事故索赔代价高昂、耗时且漫长，并且揭示了在不良结果发生后，外科医生和患者早期解决问题的机会。
