Swonke Megan L, Shakibai Nasim, Chaaban Mohamad R
Department of Otolaryngology, The University of Texas Medical Branch, Galveston, Texas, USA.
School of Medicine, University of North Texas Health Science Center, Fort Worth, Texas, USA.
OTO Open. 2020 May 13;4(2):2473974X20921141. doi: 10.1177/2473974X20921141. eCollection 2020 Apr-Jun.
This study aims to examine litigation trends with thyroidectomies in the United States from 1984 to 2018.
We used the Westlaw legal database to collect data on the defendant, plaintiff, case demographics, alleged reasons for malpractice, additional complications, and case outcomes.
The most common reason for litigation was vocal cord paralysis (51%, n = 28), with the majority ruling in favor of the defendant (64%, = .042). Of those, 43% of cases (n = 12) were due to unilateral recurrent laryngeal nerve (RLN) injury, and 39% (n = 11) were due to bilateral RLN injury. Of the claims due to vocal cord paralysis that resulted in indemnity payment (36%), the majority included additional damages, such as lack of informed consent (30%) or subsequent damages from permanent tracheostomy (40%), which is usually a result of bilateral nerve paralysis.
RLN injury was the most common complication leading to trial, with most cases ruling in favor of the defense. However, most verdicts that favored the plaintiff or those that settled were due to subsequent damages from bilateral nerve paralysis, such as permanent tracheostomy. We encourage surgeons to consider a staged procedure in high-risk cases or cases with signal loss. There needs to be a bigger emphasis on informed consent in the training of surgeons. Surgeons should educate patients at high risk on potential surgical complications that may drastically affect their quality of life.
本研究旨在调查1984年至2018年美国甲状腺切除术的诉讼趋势。
我们使用Westlaw法律数据库收集有关被告、原告、案件人口统计学、医疗事故指控原因、其他并发症和案件结果的数据。
诉讼的最常见原因是声带麻痹（51%，n = 28），大多数判决有利于被告（64%，P = .042）。其中，43%的案件（n = 12）是由于单侧喉返神经（RLN）损伤，39%（n = 11）是由于双侧RLN损伤。在因声带麻痹导致赔偿支付的索赔中（36%），大多数包括额外损害赔偿，如缺乏知情同意（30%）或永久性气管造口术的后续损害（40%）,这通常是双侧神经麻痹的结果。
RLN损伤是导致审判的最常见并发症，大多数案件判决有利于被告。然而，大多数有利于原告的判决或和解的判决是由于双侧神经麻痹的后续损害，如永久性气管造口术。我们鼓励外科医生在高风险病例或有信号丧失的病例中考虑分期手术。在外科医生的培训中需要更加强调知情同意。外科医生应该对高风险患者进行有关可能严重影响其生活质量的潜在手术并发症的教育。
