Citations

OBJECTIVE Among medical practices, surgical fields, including neurosurgery, are at a high risk for medical malpractice litigation. With meningiomas contributing to 10% of the total neurosurgery litigation cases, the aim of this study was to identify demographic characteristics, reasons for litigation, and surgical complications commonly reported in these cases. This analysis serves to increase neurosurgeons’ awareness of factors associated with medical malpractice litigation. METHODS The online legal database Westlaw was utilized to query public litigation cases related to the medical management of meningiomas between December 1985 and May 2020. Variables extracted included the following: plaintiff and defendant demographics, litigation category, plaintiff medical complaints, and trial outcomes. The authors compared these characteristics between cases with decisions in favor of the defendant and those with decisions in favor of the plaintiff. RESULTS A total of 47 cases met the inclusion criteria. Failure to diagnose (68.1%) was the most common type of malpractice claim, and surgical complications (19.1%), motor weakness (33%), and financial loss (33%) were cited as the most common postoperative complaints. Individual specialties that most often required defense due to malpractice claims were radiology (21.7%) and neurosurgery (19.6%). The jury verdict was in favor of the defense in 51.1% of cases and in favor of the plaintiff in 27.7% of cases. A settlement was reached in 19.1% of cases. The mean payout for a verdict in favor of the plaintiff was $3,409,650.22, while the mean payout for settlements was $867,555.56. The greatest average payout for specialties was in neurosurgery at $3,414,400, followed by radiology at $3,192,960. Cases with a verdict in favor of the plaintiff were more likely to involve an internal medicine physician as a defendant (p = 0.007). CONCLUSIONS Over one-half of the cases resulted in a defendant’s verdict with failure to diagnose cited as the most common reason for litigation. Radiology and neurosurgery were the most common specialties for legal cases and also had some of the largest average payouts based on specialty. Motor weakness and financial loss were the most common plaintiff postoperative complaints. These findings may inform surgeons on active measures to take, such as increasing focus on diagnostic accuracy and reducing specific postoperative complaints, such as motor weakness, through risk management and prophylactic measures, to reduce unfavorable legal outcomes.

Abstract BackgroundOur study aims to fill the vacancy of litigation studies related to trigeminal neuralgia management, and to give healthcare providers the necessary information needed to better understand the potential litigious outcomes that often follow certain treatment methods.MethodsWe queried the Westlaw Edge legal database to identify litigation cases related to the management of trigeminal neuralgia for the years 1985-2019 using the following search criteria: (trigeminal & neuralgia), (tic & douloureux) and (microvascular & decompression). Key variables extracted included the following: plaintiff medical complaints, trial outcome, payout, and demographic characteristics. Continuous variables were compared between cases in favor of defendant and cases in favor of plaintiff using t-test or Wilcoxon rank sum test. Categorical variables were compared using chi-square or Fischer’s exact test.Results49 cases met the inclusion criteria – for those cases surgical complication (42.9%) and failure to diagnose (32.7%) were cited as the most common alleged reasons for filing a malpractice claim. Cranial nerve deficits (34.7%) and loss of consortium (12.2%) were the most frequent post-operative complaints. Verdicts ruled in favor of the defendant in 61.2% of cases, and for the plaintiff in 26.5% of cases with a mean payout of $1,982,428.46. Dental specialists were included in the most cases, 63.3%, and the average payout was $415,908, while Neurosurgical specialists were involved in 20.4% of cases with an average payout of $618,775. Cases where the verdict was in favor of the plaintiff were more likely to be older than cases with a verdict in favor of the defendant (p=0.03). ConclusionsOver one-half of the cases resulted in a defendant’s verdict with surgical complications cited as the most common reason for litigation. Dentistry and neurosurgery were listed as the most common individual physician specialties for defendants, also contributing to the largest average payouts based on specialty (for specialties > 1 occurrence). Cranial nerve deficits and loss of consortium were the most common plaintiff post-operative complaints. A key implication of this study is the need for more extensive discussions between physician and patient regarding informed consent, especially when neurosurgical interventions are required.

Abstract Background Consensus in timing of radiotherapy is yet to be established in esthesioneuroblastoma (ENB). Objective This study was aimed to investigate if planned adjuvant radiotherapy improves tumor control after complete margin negative resection of low Hyams' grade (1 or 2) ENB. Methods A retrospective review of patients with pathologically confirmed negative margin resection of Kadish's stage B or C and Hyams' grade 1 and 2 ENBs was conducted. Seventeen patients meeting the criteria were divided into the following two groups for cohort study: (1) those who underwent planned immediate postoperative adjuvant radiotherapy (IR group) and (2) those who did not (delayed radiotherapy [DR] group). Results The IR group included nine patients (Kadish's stage B in one and stage C in eight; Hyams' grade 1 in two and grade 2 in seven). Mean follow-up was 140.8 months. Seven patients (78%) had disease progression (DP) at a median of 88 months (four with cervical lymph node metastasis [CLNM], one with distant metastasis, and two with both local recurrence and CLNM). One patient experienced frontal lobe abscess. The DR group included eight patients (Kadish's stage B in six and stage C in two; all Hyams' grade 2). Mean follow-up was 123.3 months. Four (50%) patients who developed DP (all local recurrence) were salvaged with surgery and adjuvant radiotherapy at a median of 37.5 months. There was no statistically significant difference in DP rate (p = 0.23), time to DP (p = 0.26), or the local tumor control rate (p = 0.23). Conclusion In our limited cohort, immediate postoperative radiotherapy did not demonstrate superiority in tumor control, although risk of radiotherapy toxicity appears low.