Department of Surgery, Texas Tech University Health Sciences Center, Lubbock, Tex; Loyola University Chicago School of Law, Chicago, Ill.
Department of Surgery, Texas Tech University Health Sciences Center, Lubbock, Tex.
J Vasc Surg. 2022 Mar;75(3):962-967. doi: 10.1016/j.jvs.2021.08.098. Epub 2021 Sep 30.
OBJECTIVE/BACKGROUND: Thoracic outlet syndrome (TOS) is most often referred to vascular surgeons. However, there is a lack of understanding of the malpractice cases involving TOS. The goal of this study is to better understand the medicolegal landscape related to the care of TOS.
The Westlaw Edge AI-powered proprietary system was retrospectively reviewed for malpractice cases involving TOS. A Boolean search strategy was used to identify target cases under the case category of "Jury Verdicts & Settlements" for all state and federal jurisdictions from 1970 to September 2020. The settled case was described but not included in the statistical analysis. Descriptive statistics were used to report our findings, and when appropriate. The P ≤ .05 decision rule was established a priori as the null hypothesis rejection criterion to determine associations between jury verdicts outcomes and state's tort reform status.
In this study, 39 cases were identified and met the study's inclusion criteria from the entire Westlaw Edge database. Among plaintiffs who disclosed age and/or gender, median age was 35.0 years with a female majority (67.6%). Cases involving TOS were noted to be steadily decreasing since the mid-1990s. The cases were unevenly spread across 18 states, with the highest number of cases (14, 35.9%) from California and the second highest (4, 10.3%) from Pennsylvania. A similar uneven distribution was seen among U.S. census regions, in which the West had the highest cases (39.5%). The study revealed that more cases were brought to trials in tort reform states (26, 68.4%) than in non-tort reform states (12, 31.6%). A total of 24 of 39 (61.5%) plaintiffs had one specific claim, which resulted in their economic and noneconomic damages. Negligent operation and treatment complication represented an overwhelming majority of claims brought by 38 of 39 plaintiffs (97.4%). Misdiagnosis and lack of informed consent were both brought nine times (23.1%) by the group. Intraoperative nerve injury (20 patients, 51.3%) was the most commonly reported complication. Excluding one case with a settlement of $965,000, 30 of 38 (78.9%) cases went to trials and received defense verdicts. Eight cases (20.5%) were found in favor of plaintiffs with a median payout of $725,581.
This study highlighted higher than average payouts to plaintiffs and risk factors that may result in malpractice lawsuits for surgeons undertaking TOS treatment. Future studies are needed to further clarify the relationships between tort reform and outcomes of malpractice cases involving TOS.
目的/背景：胸廓出口综合征（TOS）通常由血管外科医生治疗。然而，人们对涉及 TOS 的医疗事故案例缺乏了解。本研究的目的是更好地了解与 TOS 护理相关的医疗法律情况。
使用 Westlaw Edge 人工智能专有系统回顾与 TOS 相关的医疗事故案例。使用布尔搜索策略，根据所有州和联邦司法管辖区的“陪审团裁决和和解”案例类别，从 1970 年至 2020 年 9 月检索目标案例。已解决的案件虽已描述，但未包含在统计分析中。使用描述性统计数据报告我们的发现，并在适当的情况下进行报告。事先确定 P ≤.05 决策规则作为否定假设的拒绝标准，以确定陪审团裁决结果与州侵权改革状况之间的关联。
在这项研究中，从整个 Westlaw Edge 数据库中确定了 39 个符合研究纳入标准的案例。在披露年龄和/或性别的原告中，中位年龄为 35.0 岁，女性居多（67.6%）。自 20 世纪 90 年代中期以来，TOS 相关案例数量稳步下降。这些案例分布在 18 个州之间，加利福尼亚州（14 例，35.9%）和宾夕法尼亚州（4 例，10.3%）的案例数量最多。在美国人口普查地区也存在类似的分布不均，其中西部地区的案例最多（39.5%）。研究表明，在侵权改革州提起的案件（26 例，68.4%）多于非侵权改革州（12 例，31.6%）。在 39 名原告中，共有 24 名（61.5%）提出了一项具体索赔，这导致了他们的经济和非经济损失。疏忽操作和治疗并发症代表了 39 名原告中的 38 名（97.4%）提出的绝大多数索赔。误诊和缺乏知情同意都由该组提出了 9 次（23.1%）。术中神经损伤（20 例，51.3%）是最常报告的并发症。排除一例和解金额为 96.5 万美元的案件，38 例中的 30 例（78.9%）案件进入审判并获得辩护裁决。8 例（20.5%）有利于原告，平均赔付额为 725581 美元。
本研究强调了外科医生治疗 TOS 时，向原告支付的赔偿金高于平均水平，以及可能导致医疗事故诉讼的风险因素。需要进一步的研究来进一步阐明侵权改革与涉及 TOS 的医疗事故案例结果之间的关系。
