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Trauma surgery malpractice risk: perception versus reality
Ronald M Stewart1, Joe Johnston, Kathy Geoghegan
1Department of Surgery, University of Texas Health Science Center at San Antonio University Hospital, San Antonio Texas 78229, USA. stewartr@uthscsa.edu
Objective:
We set out to compare the malpractice lawsuit risk and incidence in trauma surgery, emergency surgery, and elective surgery at a single academic medical center.
Summary And Background Data:
The perceived increased malpractice risk attributed to trauma patients discourages participation in trauma call panels and may influence career choice of surgeons. When questioned, surgeons cite malpractice risk as a rationale for not providing trauma care. Little data substantiate or refute the perceived high trauma malpractice risk. We hypothesized that the malpractice risk was equivalent between an elective surgical practice and a trauma/emergency practice.
Methods:
Three prospectively maintained institutional databases were used to calculate and characterize malpractice incidence and risk: a surgical operation database, a trauma registry, and a risk management/malpractice database. Risk groups were divided into elective general surgery (ELECTIVE), urgent/emergent, nontrauma general surgery (URGENT), and trauma surgery (TRAUMA). Malpractice claims incidence was calculated by dividing the total number of filed lawsuits by the total number of operative procedures over a 12-year period.
Results:
Over the study period, 62,350 operations were performed. A total of 21 lawsuits were served. Seven were dismissed. Three were granted summary judgments to the defendants. Ten were settled with payments to the plaintiffs. One went to trial and resulted in a jury verdict in favor of the defendants. Total paid liability was 4.7 million dollars(391,667 dollars/year). Total legal defense costs were 1.3 million dollars(108,333 dollars/year). The ratio of lawsuits filed/operations performed and incidence in the 3 groups is as follows: ELECTIVE 14/39,080 (3.0 lawsuits/100,000 procedures/year), URGENT 5/17,958, (2.3 lawsuits/100,000 procedures/year), and TRAUMA 2/5312 (3.1/100,000 procedures/year). During the study period, there were an estimated 49,435 trauma patients evaluated. The incidence of malpractice lawsuits using this denominator is 0.34 lawsuits/100,000 patients/year.
Conclusions:
These data demonstrate no increased risk of lawsuit when caring for trauma patients, and the actual risk of a malpractice lawsuit was low.
Insights
The malpractice lawsuit risk for trauma surgery is not higher than for elective or emergency surgery. These findings indicate that the actual risk of a malpractice lawsuit in trauma care is low.
Area of Science:
- Medical Malpractice Law
- Surgical Outcomes Research
- Trauma Surgery
Background:
- Surgeons often perceive higher malpractice risk in trauma care, influencing career choices and participation in trauma call.
- Limited data exist to substantiate or refute the perceived high malpractice risk associated with trauma surgery.
- This study investigated the hypothesis that malpractice risk is equivalent across elective, urgent/emergent non-trauma, and trauma surgical practices.
Purpose of the Study:
- To compare the incidence and risk of malpractice lawsuits in trauma surgery versus emergency and elective surgery.
- To provide empirical data on malpractice claims to address surgeon perceptions.
- To inform surgical career choices and trauma care participation.
Main Methods:
- Utilized three institutional databases: surgical operations, trauma registry, and risk management/malpractice.
- Calculated malpractice claims incidence by dividing total lawsuits by total operative procedures over a 12-year period.
- Categorized surgical risk groups into elective general surgery (ELECTIVE), urgent/emergent non-trauma general surgery (URGENT), and trauma surgery (TRAUMA).
Main Results:
- A total of 21 lawsuits were filed out of 62,350 operations over 12 years.
- Incidence rates per 100,000 procedures: ELECTIVE (3.0), URGENT (2.3), and TRAUMA (3.1).
- The incidence of malpractice lawsuits for trauma patients evaluated was 0.34 per 100,000 patients/year.
Conclusions:
- Data show no increased risk of malpractice lawsuits when caring for trauma patients.
- The actual incidence of malpractice lawsuits in trauma surgery is low.
- Findings may help alleviate concerns regarding malpractice risk in trauma care.
