Phair John, Carnevale Matthew, Wilson Eelin, Koleilat Issam
Department of Vascular Surgery, Montefiore Medical Center, Bronx, NY, USA.
J Vasc Access. 2020 May;21(3):287-292. doi: 10.1177/1129729819872846. Epub 2019 Sep 9.
To analyze malpractice cases involving hemodialysis access to prevent future litigation and improve physician education.
Jury verdict reviews from the WESTLAW database from 1 January 2005 to 1 January 2015 were reviewed. The search terms "hemodialysis," "dialysis," "graft," "fistula," "AVG," "AVF," "arteriovenous," "catheter," "permacatheter," and "shiley" were used to compile data on the demographics of the defendant, plaintiff, allegation, complication, and verdict.
Sixty-six cases involving the litigation pertaining to hemodialysis catheter, arteriovenous fistula (AVF) or arteriovenous grafts (AVGs) were obtained. Of these, 55% involved catheter-based hemodialysis access, 18% involved AVF, and 27% involved AVG. The most frequent physician defendants were vascular surgeons (36%), internists (14%), nephrologists (14%), general surgeons (9%), and interventional radiologists (6%). Of the patients, 38% involved were male and the average patient age was 56.3 (standard deviation (SD) = 20.1) years. Region of injury was 50% in the neck or chest, 42% in the arm, and 8% in the groin. Injury was listed as death in 79% of cases. Of the deaths, 95% involved bleeding at some point in the chain of events. The most common claims related to the cases were failure to perform the surgery or procedure safely (44%), failure to diagnose and treat in a timely manner (30%), and negligent hemodialysis treatment (11%). The most common complications cited were hemorrhage (62%), loss of function of limb (15%), and ischemia due to steal syndrome (11%). A total of 26 cases (39%) were found for the plaintiff or settled. The median award was US$463,000 with a mean of US$985,299 (SD = US$1,314,557).
While popular opinion may indicate that steal syndrome is a commonly litigated complication, our data reveal that the most common injury litigated is death which may frequently be the result of a hemorrhagic episode. In addition to hemorrhage, the remaining most common complications included steal syndrome and loss of limb function. Therefore, steps to better prevent, diagnose and treat bleeding, nerve injury, and steal syndrome in a timely manner are critical to preventing hemodialysis-access-associated litigation.
分析涉及血液透析通路的医疗事故案例，以预防未来的诉讼并改善医生教育。
回顾了2005年1月1日至2015年1月1日WESTLAW数据库中的陪审团裁决。使用搜索词“血液透析”“透析”“移植物”“动静脉内瘘”“动静脉移植物”“动静脉”“导管”“长期导管”和“希利”来汇编关于被告、原告的人口统计学、指控、并发症和裁决的数据。
获得了66例涉及血液透析导管、动静脉内瘘（AVF）或动静脉移植物（AVG）诉讼的案例。其中，55%涉及基于导管的血液透析通路，18%涉及AVF，27%涉及AVG。最常见的医生被告是血管外科医生（36%）、内科医生（14%）、肾病学家（14%）、普通外科医生（9%）和介入放射科医生（6%）。在患者中，38%为男性，患者平均年龄为56.3岁（标准差（SD）=20.1）。损伤部位50%在颈部或胸部，42%在手臂，8%在腹股沟。79%的案例中损伤被列为死亡。在死亡案例中，95%在事件链的某个环节涉及出血。与这些案例相关的最常见索赔是未能安全地进行手术或操作（44%）、未能及时诊断和治疗（30%）以及疏忽的血液透析治疗（11%）。最常提及的并发症是出血（62%）、肢体功能丧失（15%）和窃血综合征导致的缺血（11%）。共有26例（39%）判决原告胜诉或达成和解。赔偿中位数为46.3万美元，平均为98.5299万美元（SD = 131.4557万美元）。
虽然普遍观点可能表明窃血综合征是一个经常被诉讼的并发症，但我们的数据显示，最常被诉讼的损伤是死亡，这可能经常是出血事件的结果。除了出血，其余最常见的并发症包括窃血综合征和肢体功能丧失。因此，采取措施更好地及时预防、诊断和治疗出血、神经损伤和窃血综合征对于预防与血液透析通路相关的诉讼至关重要。
