Medicolegal litigation in general surgery: a comparison between England and the United States

Clinical negligence claims represent a significant financial and reputational burden for healthcare systems worldwide. While the United States is often perceived as having a highly litigious medical culture, comparative data between the United Kingdom and United States, especially in general surgery, are limited.

Data on clinical negligence claims in general surgery were obtained through a Freedom of Information (FOI) request to NHS Resolution for England, covering financial years 2013/2014 to 2021/2022 and national databases from the United States between 2014 and 2022. Only successful claims with awarded damages were included. Population-adjusted annual means, total claim volumes and associated costs were calculated.

England recorded 5829 successful claims in general surgery over 9 years, with an estimated total cost of £873 million. The United States recorded 12 162 successful claims, which adjusted for population equated to 2043 claims, with an estimated adjusted cost of £563 million. England had three times more population-adjusted successful claims than the United States and nearly double the associated costs. The most common cause of successful litigation in England was "failure or delay in treatment". Only 6.1% of successful claims were attributed to "operator error".

Despite the United States' reputation for higher litigation, England had more successful, population-adjusted general surgery claims and costs over the study period. These findings highlight the importance of systemic, cultural and structural differences in how claims are handled and resolved in each healthcare system.