Department of Neurosurgery, Atkinson Morley Wing, St George's Hospital, London, UK.
Br J Neurosurg. 2022 Feb;36(1):75-78. doi: 10.1080/02688697.2021.1973370. Epub 2021 Sep 11.
The burden of medicolegal claims in neurosurgery is increasing in the UK. Trepidation associated with malpractice claims has the potential to negatively impact surgical practice and patient safety. What are the causes of these claims and can we address them? The aim of this study was to identify the incidence and total burden of litigation claims related to neurosurgery in a London tertiary center.We retrospectively reviewed all consecutive cases of claims in neurosurgery that were reported to NHSR between March 2013 and April 2018 by St George's Hospital legal department. This was an extension of previous study by Mukherjee et al., who studied the medicolegal claims in our institution in the preceding 9-year period (2004-2013).There were 18 litigation claims against neurosurgery. Claims were reviewed for clinical event, cause, likelihood of pay-out and legal outcome. Eleven claims were settled in court and seven were settled without court proceeding. All claims were spinal cases, 56% emergency admissions. Causes included faulty surgical technique (39%), delayed treatment (33%), delayed diagnosis/misdiagnosis (17%), and lack of information (11%) with a likelihood of financial success of 43%, 67%, 33%, and 100%, respectively. The highest median pay-outs were for lack of information (£2.8 million) and faulty surgical technique (£1 million). When compared to the preceding 9-year period, there a modest reduction in claims per year, despite an increase in workload. Distribution of litigation causes remained similar but overall financial burden was higher.Spinal surgery has the highest malpractice claim risk in neurosurgical practice. Our review shows that faulty surgical technique is the leading cause of neurosurgical claims. Claims against lack of information, although less frequent, resulted in the highest median pay-out. This study reinforces previously published data that good surgical technique and thorough process of informed consent may reduce litigation in neurosurgery.
在英国，神经外科的医疗法律诉讼负担正在增加。与医疗事故索赔相关的恐惧有可能对手术实践和患者安全产生负面影响。这些索赔的原因是什么，我们能否解决这些问题？本研究的目的是确定在伦敦一家三级中心神经外科相关诉讼索赔的发生率和总负担。我们回顾性地审查了圣乔治医院法律部门在 2013 年 3 月至 2018 年 4 月期间向 NHSR 报告的神经外科连续病例中的所有索赔。这是 Mukherjee 等人之前研究的扩展，他们研究了我们机构在之前 9 年期间（2004-2013 年）的医疗法律索赔。共有 18 项针对神经外科的诉讼索赔。对临床事件、原因、赔付可能性和法律结果进行了审查。11 项索赔在法庭上得到解决，7 项在没有法庭程序的情况下得到解决。所有索赔均为脊柱病例，56%为急诊入院。原因包括手术技术失误（39%）、治疗延误（33%）、诊断/误诊延误（17%）和信息缺乏（11%），财务成功的可能性分别为 43%、67%、33%和 100%。信息缺乏（280 万英镑）和手术技术失误（100 万英镑）的最高中位数赔付额最高。与前 9 年相比，尽管工作量增加，但每年的索赔数量略有减少。诉讼原因的分布仍然相似，但总体财务负担更高。脊柱手术是神经外科实践中医疗法律诉讼风险最高的手术。我们的审查表明，手术技术失误是神经外科索赔的主要原因。尽管信息缺乏的索赔频率较低，但中位数赔付额最高。本研究证实了之前发表的数据，即良好的手术技术和详尽的知情同意过程可能会减少神经外科的诉讼。
