1Department of Neurological Surgery, Montefiore Medical Center, New York.
2Department of Neurological Surgery, Albert Einstein College of Medicine, New York, New York; and.
Neurosurg Focus. 2020 Nov;49(5):E22. doi: 10.3171/2020.8.FOCUS20598.
Among medical practices, surgical fields, including neurosurgery, are at a high risk for medical malpractice litigation. With meningiomas contributing to 10% of the total neurosurgery litigation cases, the aim of this study was to identify demographic characteristics, reasons for litigation, and surgical complications commonly reported in these cases. This analysis serves to increase neurosurgeons' awareness of factors associated with medical malpractice litigation.
The online legal database Westlaw was utilized to query public litigation cases related to the medical management of meningiomas between December 1985 and May 2020. Variables extracted included the following: plaintiff and defendant demographics, litigation category, plaintiff medical complaints, and trial outcomes. The authors compared these characteristics between cases with decisions in favor of the defendant and those with decisions in favor of the plaintiff.
A total of 47 cases met the inclusion criteria. Failure to diagnose (68.1%) was the most common type of malpractice claim, and surgical complications (19.1%), motor weakness (33%), and financial loss (33%) were cited as the most common postoperative complaints. Individual specialties that most often required defense due to malpractice claims were radiology (21.7%) and neurosurgery (19.6%). The jury verdict was in favor of the defense in 51.1% of cases and in favor of the plaintiff in 27.7% of cases. A settlement was reached in 19.1% of cases. The mean payout for a verdict in favor of the plaintiff was $3,409,650.22, while the mean payout for settlements was $867,555.56. The greatest average payout for specialties was in neurosurgery at $3,414,400, followed by radiology at $3,192,960. Cases with a verdict in favor of the plaintiff were more likely to involve an internal medicine physician as a defendant (p = 0.007).
Over one-half of the cases resulted in a defendant's verdict with failure to diagnose cited as the most common reason for litigation. Radiology and neurosurgery were the most common specialties for legal cases and also had some of the largest average payouts based on specialty. Motor weakness and financial loss were the most common plaintiff postoperative complaints. These findings may inform surgeons on active measures to take, such as increasing focus on diagnostic accuracy and reducing specific postoperative complaints, such as motor weakness, through risk management and prophylactic measures, to reduce unfavorable legal outcomes.
在医疗实践中，包括神经外科在内的外科领域存在着较高的医疗事故诉讼风险。脑膜瘤占神经外科总诉讼案件的 10%，本研究旨在确定这些病例中常见的人口统计学特征、诉讼原因和手术并发症。本分析旨在提高神经外科医生对与医疗事故诉讼相关因素的认识。
本研究使用在线法律数据库 Westlaw 检索了 1985 年 12 月至 2020 年 5 月期间与脑膜瘤医疗管理相关的公开诉讼案例。提取的变量包括：原告和被告的人口统计学特征、诉讼类别、原告的医疗投诉和审判结果。作者比较了这些特征在有利于被告的案件和有利于原告的案件之间的差异。
共有 47 例符合纳入标准。漏诊（68.1%）是最常见的医疗事故索赔类型，手术并发症（19.1%）、运动无力（33%）和经济损失（33%）是最常见的术后投诉。由于医疗事故索赔而最需要辩护的个别专业是放射科（21.7%）和神经外科（19.6%）。陪审团裁决有利于被告的案件占 51.1%，有利于原告的案件占 27.7%。19.1%的案件达成和解。有利于原告的判决的平均赔偿金为 3409650.22 美元，和解的平均赔偿金为 867555.56 美元。专业平均支出最高的是神经外科，为 3414400 美元，其次是放射科，为 3192960 美元。有利于原告的判决的案件更有可能涉及内科医生作为被告（p=0.007）。
超过一半的案件的判决有利于被告，漏诊是诉讼的最常见原因。放射科和神经外科是法律案件最常见的专业，也是根据专业划分平均支出最高的科室。运动无力和经济损失是最常见的原告术后投诉。这些发现可以为外科医生提供信息，告知他们采取积极措施，如提高诊断准确性，并通过风险管理和预防措施减少特定的术后投诉，如运动无力，以降低不利的法律后果。
