Ji Yisi D, Peacock Zachary S, Resnick Cory M
MD Candidate, Harvard Medical School, Boston, MA.
Assistant Professor of Oral and Maxillofacial Surgery, Harvard School of Dental Medicine and Harvard Medical School, Boston, MA; and Oral and Maxillofacial Surgeon, Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Boston, MA.
J Oral Maxillofac Surg. 2020 Aug;78(8):1314-1318. doi: 10.1016/j.joms.2020.03.015. Epub 2020 Mar 23.
Insight into the causes and outcomes of malpractice claims against surgeons will help inform practitioners and may support better patient care. The purpose of this study was to characterize national malpractice claims against oral and maxillofacial surgeons (OMSs).
A comprehensive review of all claims against OMSs from 2000 to August 2018 in the National Practitioner Data Bank was performed. Primary outcomes were claims against OMSs, payment amount, claim duration, and percentage of anesthesia-related claims. Other variables of interest included demographic characteristics, nature of allegations, clinical outcome of injury, outcome of claim, and number of payments of $1 million or greater ("catastrophic payments"). Student t tests and Wilcoxon rank-sum test were performed, and P < .05 was considered significant.
This was a retrospective cohort study of malpractice claims against OMSs. There were 2,643 claims against OMSs during the study period. The average age of the claimant was 35.5 ± 18.4 years, and 47.6% were female patients. Most claims (94.7%) were settled out of court for a mean of $130,824 ± $402,633.8. Court-adjudicated claims had significantly higher payments with a mean of $247,554.69 ± $414,655.51 (P < .0001). The average duration from time of event to conclusion of claim was significantly shorter for settled claims (3.5 ± 2.3 years) than for claims that were court adjudicated (5.2 ± 2.7 years) (P < .0001). Anesthesia-related claims made up 3.63% of the total, and 0.56% of claims were pediatric anesthesia related. Anesthesia-related payments were significantly higher than other claims (P < .0001). The most common type of allegation was "surgery-related" injuries (63.1%), followed by "treatment-related" injuries (22.2%). The most common clinical outcome was minor permanent injury (34.6%).
Most claims against OMSs were settled. Only a small portion of claims were associated with anesthesia complications, but payment amounts for these were significantly higher than for other claims. Settlements were made more quickly and for significantly lower rewards compared with judgments. Claims against OMSs during the past 2 decades were most commonly associated with minor permanent injuries occurring in the outpatient setting.
深入了解针对外科医生的医疗事故索赔的原因和结果，将有助于为从业者提供信息，并可能支持更好的患者护理。本研究的目的是描述针对口腔颌面外科医生（OMS）的全国性医疗事故索赔情况。
对2000年至2018年8月期间国家从业者数据库中针对OMS的所有索赔进行了全面审查。主要结果是针对OMS的索赔、赔付金额、索赔持续时间以及麻醉相关索赔的百分比。其他感兴趣的变量包括人口统计学特征、指控性质、损伤的临床结果、索赔结果以及赔付金额为100万美元或更高的赔付次数（“灾难性赔付”）。进行了学生t检验和Wilcoxon秩和检验，P < 0.05被认为具有统计学意义。
这是一项针对OMS医疗事故索赔的回顾性队列研究。在研究期间，针对OMS有2643起索赔。索赔人的平均年龄为35.5±18.4岁，47.6%为女性患者。大多数索赔（94.7%）在庭外和解，平均赔付金额为130,824±402,633.8美元。经法院判决的索赔赔付金额显著更高，平均为247,554.69±414,655.51美元（P < 0.0001）。从事件发生到索赔结束的平均持续时间，和解索赔（3.5±2.3年）明显短于经法院判决的索赔（5.2±2.7年）（P < 0.0001）。麻醉相关索赔占总数的3.63%，0.56%的索赔与儿科麻醉相关。麻醉相关赔付显著高于其他索赔（P < 0.0001）。最常见的指控类型是“手术相关”损伤（63.1%），其次是“治疗相关”损伤（22.2%）。最常见的临床结果是轻度永久性损伤（34.6%）。
针对OMS的大多数索赔已达成和解。只有一小部分索赔与麻醉并发症相关，但这些索赔的赔付金额显著高于其他索赔。与判决相比，和解达成得更快，赔付金额也显著更低。在过去20年中，针对OMS的索赔最常与门诊环境中发生的轻度永久性损伤相关。
