University of Maryland School of Medicine, Baltimore, Maryland, USA.
Division of Urology, Department of Surgery, University of Maryland Medical Center, Baltimore, Maryland, USA.
J Endourol. 2021 Aug;35(8):1158-1162. doi: 10.1089/end.2020.0427. Epub 2021 Jan 21.
The litigious environment encompassing the medical-legal domain is an increasing concern for surgical fields, with urology being no exception. The objective of our study was to systematically review, evaluate, and summarize the factors associated with oncologic nephrectomy litigation to determine possible factors contributing to verdicts or settlements. Publicly available verdict reports were retrieved using the Westlaw legal database (Reuters). Cases were identified using the search term "nephrectomy" with dates ranging from January 1, 1990 to July 1, 2019. Each case was evaluated by two independent reviewers for defendant specialty, alleged breach in treatment, resulting complications, verdict outcomes, and indemnity payment. Complications were determined to be preoperative, perioperative, and postoperative. Data were analyzed using SPSS software to produce the descriptive statistics. After accounting for duplicates and irrelevant cases, a total of 103 cases were analyzed with more than three-fourths being radical nephrectomies (78%). The most common claim was preoperative negligence (48%); however, negligence in perioperative care received the highest average monetary payment of $5,493,151. Forty-one percent of cases were perioperative with the majority being attributed to vascular injury (46%). The type of perioperative negligence claims and its average payment were found to be statistically significant ( = 0.042). Overall, 57% of cases denied the plaintiff's claims, whereas 28% were awarded. Our data show that although the highest number of cases were caused by preoperative negligence, perioperative negligence accounts for the highest settlement awards. This review provides insights into stages of management in the surgical management of renal cell cancer patients that may be subject to litigation.
法律医学领域的诉讼环境日益引起外科领域的关注，泌尿科也不例外。我们的研究目的是系统地回顾、评估和总结与肿瘤性肾切除术诉讼相关的因素，以确定可能导致判决或和解的因素。使用 Westlaw 法律数据库（Reuters）检索公开可得的判决报告。使用搜索词“肾切除术”，日期范围从 1990 年 1 月 1 日至 2019 年 7 月 1 日，确定案例。每个案例由两名独立审查员评估被告专业、治疗中据称的违约、导致的并发症、判决结果和赔偿支付。并发症被确定为术前、围手术期和术后。使用 SPSS 软件分析数据以产生描述性统计数据。在考虑重复和不相关的案例后，共分析了 103 例病例，其中超过四分之三是根治性肾切除术（78%）。最常见的索赔是术前疏忽（48%）；然而，围手术期护理中的疏忽获得了最高的平均赔偿金 5,493,151 美元。41%的病例是围手术期，大多数归因于血管损伤（46%）。围手术期疏忽索赔的类型及其平均赔偿金额被发现具有统计学意义（=0.042）。总体而言，57%的病例否认了原告的索赔，而 28%的病例被授予。我们的数据表明，尽管术前疏忽导致的病例数量最多，但围手术期疏忽导致的和解赔偿金额最高。这项审查提供了对肾癌患者手术管理中可能引起诉讼的管理阶段的深入了解。
