Pearls and pitfalls: medico-legal considerations for sinus surgery

Patients being treated for chronic rhinosinusitis, whether via medical or surgical means, account for a significant percentage of all medical malpractice claims against otolaryngologists. In this study, we present suggestions to help otolaryngologists safeguard against unnecessary claims.

A significant proportion of malpractice claims associated with sinus surgery refer to failure of the physician to provide proper and complete informed consent. Poor physician communication and interpersonal skills, withholding information, and the impression that the physician is rushed and uninterested in patients' concerns appear to be associated with a higher risk of litigation.

For endoscopic sinus surgery, there are no set standards that delineate which complications are to be discussed; however, a frequently quoted suggestion has been to discuss complications specific to a procedure that occur in more than 1% of cases or are considered catastrophic in nature. Otolaryngologists should keep in mind that smell disturbances are common after endoscopic sinus surgery and consider discussing smell disorders as a potential risk during the informed consent process. If there will be a different physician performing the surgery, this should be discussed with the patient, and written in the consent. The surgeon should ensure that the patient understands the risks and the alternatives to surgery. Ideally, documentation is created that attests that the physician solicited and answered all of a patient's questions. When a complication occurs or if a patient is unhappy with the outcome of surgery, the physician should take extra care and time addressing the issue directly with the patient. Diligent documentation at every point is a crucial safeguarding step.