Patients who underwent elective surgery were more likely to file complaints than emergency patients

The field of orthopedic surgery has a high incidence of medical malpractice claims, resulting in a relative risk of 99% for each surgeon to receive at least one claim in his/her career. In recent literature, the increasing number of medical litigations, both in terms of the number of cases being filed and the substantive costs associated with lawsuits, has been described.

Martin Gathen et al conducted a study at Bonn, Germany to describe an overview of the profile of litigation for orthopedic and trauma surgery to describe the differences and the development of the number of cases over time.

A retrospective review of all litigations between 2000 and 2017 was conducted using the institutional legal database. The institution is a 120-bed university hospital serving as a tertiary care center for spine surgery and arthroplasty. The institution is also a level I trauma center. The causes of litigation were documented and classified into seven major categories. In addition to plaintiff characteristics, the litigation outcomes and the differences between emergency and elective surgery were analyzed.

Key findings of the study were:

• A total of 230 cases were evaluated.

• The mean age of the plaintiffs was 44.6±20.1 years, and 56.8% were female.

• The main reasons for litigation were claimed inappropriate management (46.1%), misdiagnosis (22.6), and poor nursing care (8.3%).

• The most common symptoms and complaints raised in the context of the litigation were mobility problems (37.2%), discomfort and pain (15.9%), and poor surgery outcome requiring reoperation (15.2%)

• Significantly more litigations were filed against surgeons of the orthopedic subspecialty compared with trauma surgeons (78%; p ≤ 0.0001).

• There were significantly fewer litigations per 1000 cases fled overall in 2009–2017 (65% less; p=0.003) than in 2000–2008.

The authors concluded that – "the findings could not confirm the often stated trend of an increasing number of litigations against orthopedic and trauma surgeons. Claimed inappropriate management was the main reason for litigation in our institution. The risk of facing litigation was significantly higher for surgeons performing elective orthopedic surgery than for trauma surgeons."

Further reading:

Litigations in orthopedics and trauma surgery: reasons, dynamics, and profiles Martin Gathen, M. Jaenisch et al Archives of Orthopaedic and Trauma Surgery (2022) 142:3659–3665 https://doi.org/10.1007/s00402-021-03958-1