Cranial surgery less likely than spine surgery to result in litigation

The study showed death or spinal cord injury were the strongest predictors of litigation in neurosurgery.

SAN FRANCISCO — Death or spinal cord injury were the strongest predictors of litigation in neurosurgery and cranial surgery was less likely than spine surgery to result in litigation, according to data from a review study presented here.

Perspective from Mohamad Bydon, MD; Ali Bydon, MD; and Ziya L. Gokaslan, MD

“We usually have complaints made because of surgical technique, but certainly preoperative, postoperative and nonoperative care are all also important contributors to litigation,” Christopher L. Taylor, MD, MBA, FAANS, said at the American Association of Neurological Surgeons Annual Meeting.

In his presentation, Taylor reviewed publically reported civil cases related to neurosurgery practice which were completed in 2012. Using the WestLawNext database and Medical Malpractice Verdicts, Settlements, & Experts reports, he identified 44 cases involving allegation of malpractice against a neurosurgeon. Cases related to spine surgery were most common, however, there was a lesser risk of litigation following cranial surgery than following spine surgery.

Christopher L. Taylor

“Spine surgery is the most common type of procedure resulting in litigation, but it is also the most common type of procedure in neurosurgical practice,” he said.

Taylor said the strongest predictors of ligation were when plaintiffs died and when a patient became paraplegic or quadriplegic, which accounted for 18% and 25% of the cases, respectively. In 55% of the cases, the primary allegation was directly related to surgery, however, preoperative care (14%), postoperative care (14%) and nonoperative management (18%) were also found to be significant contributors to lawsuits.

Death, paraplegia or quadriplegia was present in 43% of cases, based on the results.

Taylor found 64% of the verdicts studied were in favor of the defense and 36% of the cases were favorable for the plaintiffs or reached a settlement. The median award after verdict for the plaintiff was $691,565 and the median reported settlement was $777,500. The average time to case closure was 68 months with a maximum time to closure of 11 years, 10 months. – by Kristine Houck, MA, ELS

Reference:

Taylor CL. Paper #715. Presented at: American Association of Neurological Surgeons Annual Meeting; April 5-9, 2014; San Francisco.

For more information:

Christopher L. Taylor, MD, MBA, FAANS, can be reached in the Department of Neurosurgery, MSC 10-5615, University of New Mexico, Albuquerque, NM 87131; email: ctaylor@salud.unm.edu.
Disclosure: Taylor has no relevant financial disclosures.

Perspective

Mohamad Bydon, MD; Ali Bydon, MD; and Ziya L. Gokaslan, MD

A study by Christopher L. Taylor, MD, MBA, FAANS found that death or spinal cord injury following spinal surgery was the most powerful predictor of litigation in neurosurgery and observed more broadly that spine surgery was the most common procedure resulting in litigation.

The study included 44 cases in 2012 of malpractice claims against a neurosurgeon using the WestLawNext database and Medical Malpractice Verdicts, Settlements, & Experts reports. Death or paraplegia was present in approximately half of cases. Interestingly, nearly two thirds of cases resulted in a verdict for the defense, while the other third was split between settlements and verdicts for the plaintiff.

This is an interesting study and one that validates that the leading predictors of litigation in our field are death or spinal cord injury. Cauda equina is an example of this trend. Recently, a study from Johns Hopkins presented at the American Association of Neurological Surgeons Annual Meeting, “Time to Surgery Does Not Impact Outcomes in Cauda Equina” and a meta-analysis by Tien Chau and colleagues found time to surgery does not impact outcomes for cauda equina. However, these findings notwithstanding, juries continue to value time to surgery in litigation cases relating to cauda equina. A study by Daniels and colleagues found that delayed time to surgery in cauda equina is the greatest predictor of large jury trial plaintiff awards. As neurosurgeons, it is important we continue to evaluate and study surgical outcomes. Such studies will help us in educating the scientific community and the public at large, and will ultimately result in improved patient outcomes.

Mohamad Bydon, MD; Ali Bydon, MD; and Ziya L. Gokaslan, MD

Department of Neurosurgery

Johns Hopkins University School of Medicine

Baltimore

Disclosures: Mohamad Bydon, Ali Bydon and Gokaslan have no relevant financial disclosures.