1The Warren Alpert Medical School of Brown University, Providence; and.
2Departments of Neurosurgery and.
Neurosurg Focus. 2020 Nov;49(5):E21. doi: 10.3171/2020.8.FOCUS20601.
Medical malpractice litigation is a significant challenge in neurosurgery, with more than 25% of a neurosurgeon's career on average spent with an open malpractice claim. While earlier research has elucidated characteristics of litigation related to brain tumor treatment, factors impacting outcome and indemnity payment amount are incompletely understood.
The authors identified all medical malpractice cases related to brain tumors from 1988 to 2017 in VerdictSearch, a database of 200,000 cases from all 50 states. The outcome for each case was dichotomized from the perspective of the defendant physician as favorable (defendant victory) or unfavorable (plaintiff victory or settlement). Indemnity payments were recorded for cases that resulted in settlement or plaintiff victory. Univariate regression was used to assess the association between case characteristics and case outcome as well as indemnity payment amount. Subsequently, significant variables were used to generate multivariate models for each outcome. Statistical significance was maintained at p < 0.05.
A total of 113 cases were analyzed, resulting most commonly in defendant (physician) victory (46.9%), followed by settlement and plaintiff victory (both 26.5%). The most common specialty of the primary defendant was neurosurgery (35.4%), and the most common allegation was improper diagnosis (59.3%). Indemnity payments totaled $191,621,392, with neurosurgical defendants accounting for $109,000,314 (56.9%). The average payments for cases with a plaintiff victory ($3,333,654) and for settlements ($3,051,832) did not significantly differ (p = 0.941). The highest rates of unfavorable outcomes were observed among radiologists (63.6%) and neurosurgeons (57.5%) (p = 0.042). On multivariate regression, severe disability was associated with a lower odds of favorable case outcome (OR 0.21, p = 0.023), while older plaintiff age (> 65 years) predicted higher odds of favorable outcome (OR 5.75, p = 0.047). For 60 cases resulting in indemnity payment, higher payments were associated on univariate analysis with neurosurgeon defendants (β-coefficient = 2.33, p = 0.017), whether the plaintiff underwent surgery (β-coefficient = 2.11, p = 0.012), and the plaintiff experiencing severe disability (β-coefficient = 4.30, p = 0.005). Following multivariate regression, only medical outcome was predictive of increased indemnity payments, including moderate disability (β-coefficient = 4.98, p = 0.007), severe disability (β-coefficient = 6.96, p = 0.001), and death (β-coefficient = 3.23, p = 0.027).
Neurosurgeons were the most common defendants for brain tumor malpractice litigation, averaging more than $3 million per claim paid. Older plaintiff age was associated with case outcome in favor of the physician. Additionally, medical outcome was predictive of both case outcome and indemnity payment amount.
医疗事故诉讼是神经外科面临的重大挑战，平均有超过 25%的神经外科医生职业生涯都在处理悬而未决的医疗事故诉讼。虽然早期的研究已经阐明了与脑瘤治疗相关的诉讼特征，但影响结果和赔偿金额的因素仍不完全清楚。
作者从 VerdictSearch 数据库中确定了 1988 年至 2017 年所有与脑瘤相关的医疗事故诉讼案件，该数据库是来自全美 50 个州的 20 万例案件的数据库。从被告医生的角度来看，每个案件的结果都分为有利（被告胜诉）或不利（原告胜诉或和解）两种情况。对于导致和解或原告胜诉的案件，记录了赔偿金额。单变量回归用于评估病例特征与病例结果以及赔偿金额之间的关系。随后，使用显著变量为每种结果生成多变量模型。维持统计学意义的 p 值为<0.05。
共分析了 113 例，最常见的结果是被告（医生）胜诉（46.9%），其次是和解和原告胜诉（均为 26.5%）。主要被告的最常见专业是神经外科（35.4%），最常见的指控是不当诊断（59.3%）。赔偿总额为 19162.1392 万美元，其中神经外科医生被告赔偿 10900.0314 万美元（56.9%）。原告胜诉（333.3654 万美元）和和解（305.1832 万美元）的平均赔偿金额没有显著差异（p=0.941）。放射科医生（63.6%）和神经外科医生（57.5%）的不良结果发生率最高（p=0.042）。多变量回归显示，严重残疾与较低的有利病例结果几率相关（OR 0.21，p=0.023），而年龄较大的原告（>65 岁）预测有利结果的几率更高（OR 5.75，p=0.047）。对于导致赔偿的 60 个病例，单变量分析显示，较高的赔偿金额与神经外科医生被告（β系数=2.33，p=0.017）、原告是否接受手术（β系数=2.11，p=0.012）和原告出现严重残疾（β系数=4.30，p=0.005）有关。在多变量回归后，只有医疗结果可预测赔偿金额的增加，包括中度残疾（β系数=4.98，p=0.007）、严重残疾（β系数=6.96，p=0.001）和死亡（β系数=3.23，p=0.027）。
神经外科医生是脑瘤医疗事故诉讼中最常见的被告，每个案件的平均赔偿金额超过 300 万美元。原告年龄较大与医生有利的病例结果相关。此外，医疗结果可预测病例结果和赔偿金额。
