Rajshri M Gartland1,2, Jordan P Bloom1, Zhi Ven Fong1, Courtney DeRoo3, Kathy Dwyer3, Gene Quinn3, Keith Lillemoe1, Elizabeth Mort2,4. 1. Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA. 2. Edward P. Lawrence Center for Quality and Safety, Massachusetts General Hospital, Boston, MA. 3. CRICO Risk Management Foundation, Boston, MA. 4. Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
Abstract
OBJECTIVE: We aimed to study the contributing factors and costs of malpractice claims involving the surgical management of benign biliary disease given the emotional, physical, and financial toll of these claims on patients, providers, and the healthcare system. SUMMARY BACKGROUND DATA: Cholecystectomy complications carry significant morbidity and rank among the leading sources of surgical malpractice claims. METHODS: Using the CRICO Strategies' Comparative Benchmarking System database, representing approximately 30% of all paid and unpaid malpractice claims in the United States, 4081 closed claims filed against general surgeons from 1995 to 2015 were reviewed to isolate 745 cholecystectomy-related claims. A multivariable model was used to determine factors associated with claim outcome. RESULTS: The most common associated complications included bile duct injury (n = 397), bowel perforation (n = 96), and hemorrhage (n = 78). Bile duct injuries were recognized intraoperatively only 19% of the time and required biliary reconstruction surgery 77% of the time. The total cost for all claims over the study period was over $128 M and the median time from event to case close was over 3 years. 40% of claims resulted in patient payout; of these, most claims were settled out of court and the median cost per claim was $264,650. For the 60% of claims not resulting in patient payout, most cases were denied, dropped, or dismissed, yet still averaged over $15,000 per claim in legal and administrative fees. On multivariable analysis, bile duct injury, bowel perforation, and high clinical severity were associated with patient payout, while a resident or fellow being named in a claim was negatively associated with patient payout (P < 0.05). CONCLUSION: Cholecystectomy-related claims are costly and time-consuming. Strategies that reduce the risk and aid in recognition of cholecystectomy complications, as well as advance support of patients and families after poor outcomes, may improve clinical care and reduce claim burden.
OBJECTIVE: We aimed to study the contributing factors and costs of malpractice claims involving the surgical management of benign biliary disease given the emotional, physical, and financial toll of these claims on patients, providers, and the healthcare system. SUMMARY BACKGROUND DATA: Cholecystectomy complications carry significant morbidity and rank among the leading sources of surgical malpractice claims. METHODS: Using the CRICO Strategies' Comparative Benchmarking System database, representing approximately 30% of all paid and unpaid malpractice claims in the United States, 4081 closed claims filed against general surgeons from 1995 to 2015 were reviewed to isolate 745 cholecystectomy-related claims. A multivariable model was used to determine factors associated with claim outcome. RESULTS: The most common associated complications included bile duct injury (n = 397), bowel perforation (n = 96), and hemorrhage (n = 78). Bile duct injuries were recognized intraoperatively only 19% of the time and required biliary reconstruction surgery 77% of the time. The total cost for all claims over the study period was over $128 M and the median time from event to case close was over 3 years. 40% of claims resulted in patient payout; of these, most claims were settled out of court and the median cost per claim was $264,650. For the 60% of claims not resulting in patient payout, most cases were denied, dropped, or dismissed, yet still averaged over $15,000 per claim in legal and administrative fees. On multivariable analysis, bile duct injury, bowel perforation, and high clinical severity were associated with patient payout, while a resident or fellow being named in a claim was negatively associated with patient payout (P < 0.05). CONCLUSION: Cholecystectomy-related claims are costly and time-consuming. Strategies that reduce the risk and aid in recognition of cholecystectomy complications, as well as advance support of patients and families after poor outcomes, may improve clinical care and reduce claim burden.
Authors: Lidia Castagneto-Gissey; Maria Francesca Russo; Alessandra Iodice; James Casella-Mariolo; Angelo Serao; Andrea Picchetto; Giancarlo D'Ambrosio; Irene Urciuoli; Alessandro De Luca; Bruno Salvati; Giovanni Casella Journal: J Clin Med Date: 2022-06-17 Impact factor: 4.964
Authors: Rajshri M Gartland; Jordan P Bloom; Sareh Parangi; Richard Hodin; Courtney DeRoo; Antonia E Stephen; Vinod Narra; Carrie C Lubitz; Elizabeth Mort Journal: World J Surg Date: 2019-11 Impact factor: 3.352
Authors: Rajshri M Gartland; Laura C Myers; J Bryan Iorgulescu; Anthony T Nguyen; C Winnie Yu-Moe; Bianca Falcone; Richard Mitchell; Allen Kachalia; Elizabeth Mort Journal: J Patient Saf Date: 2021-12-01 Impact factor: 2.844