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Erschienen in: Journal of Gastrointestinal Surgery 1/2017

11.10.2016 | 2016 SSAT Plenary Presentation

Medical Malpractice in Bariatric Surgery: a Review of 140 Medicolegal Claims

verfasst von: Asad J. Choudhry, Nadeem N. Haddad, Matthew Martin, Cornelius A. Thiels, Elizabeth B. Habermann, Martin D. Zielinski

Erschienen in: Journal of Gastrointestinal Surgery | Ausgabe 1/2017

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Abstract

Objective

Given the current rate of obesity in the USA, it has been estimated that close to half of the US adult population could be obese by 2030, resulting in greater demand for bariatric procedures. Our objective was to analyze malpractice litigation related to bariatric surgery.

Methods

We conducted a retrospective review of Westlaw (Thompson Reuters) of all bariatric operations that resulted in the filing of a malpractice claim. Each case was reviewed for pertinent medicolegal information related to the procedure, claim, and trial.

Results

The search criteria yielded 298 case briefs, of which 140 met inclusion criteria. Thirty-two percent (n = 49) of cases involved male plaintiffs (patients). Mean patient age with standard deviation (SD) was 43 (10) years. The most common procedure litigated was the Roux-en-Y gastric bypass (76 %, n = 107). Overall, the most common alleged reason for a malpractice claim was delay in diagnosis or management of a complication in the postoperative period (n = 66, 47 %), the most common of which was an anastomotic leak (45 %, n = 34). Death was reported in 74 (52 %) cases. Fifty-seven cases (47 %) were decided in favor of the plaintiff (patient), with a median award payout of $1,090,000 (interquartile range [IQR] $412,500 to $2,550,000).

Conclusion

Delay in diagnosing or managing complications in the postoperative setting, most commonly an anastomotic leak, accounted for the majority of malpractice claims. Measures taken to identify and address anastomotic leaks and other complications early in the postoperative period could potentially reduce the amount of filed malpractice claims related to bariatric surgery.
Level of Evidence: III
Literatur
1.
Zurück zum Zitat Ogden CL, Carroll MD, Fryar CD, Flegal KM. Prevalence of Obesity Among Adults and Youth: United States, 2011–2014. NCHS Data Brief. 2015(219):1–8. Ogden CL, Carroll MD, Fryar CD, Flegal KM. Prevalence of Obesity Among Adults and Youth: United States, 2011–2014. NCHS Data Brief. 2015(219):1–8.
2.
Zurück zum Zitat Finkelstein EA, Trogdon JG, Cohen JW, Dietz W. Annual medical spending attributable to obesity: payer-and service-specific estimates. Health Aff (Millwood). 2009;28(5):w822-831.CrossRef Finkelstein EA, Trogdon JG, Cohen JW, Dietz W. Annual medical spending attributable to obesity: payer-and service-specific estimates. Health Aff (Millwood). 2009;28(5):w822-831.CrossRef
3.
Zurück zum Zitat Christou NV, Sampalis JS, Liberman M, et al. Surgery decreases long-term mortality, morbidity, and health care use in morbidly obese patients. Ann Surg. 2004;240(3):416–423; discussion 423–414.CrossRefPubMedPubMedCentral Christou NV, Sampalis JS, Liberman M, et al. Surgery decreases long-term mortality, morbidity, and health care use in morbidly obese patients. Ann Surg. 2004;240(3):416–423; discussion 423–414.CrossRefPubMedPubMedCentral
4.
Zurück zum Zitat Ponce J, Nguyen NT, Hutter M, Sudan R, Morton JM. American Society for Metabolic and Bariatric Surgery estimation of bariatric surgery procedures in the United States, 2011–2014. Surg Obes Relat Dis. 2015;11(6):1199–1200.CrossRefPubMed Ponce J, Nguyen NT, Hutter M, Sudan R, Morton JM. American Society for Metabolic and Bariatric Surgery estimation of bariatric surgery procedures in the United States, 2011–2014. Surg Obes Relat Dis. 2015;11(6):1199–1200.CrossRefPubMed
5.
Zurück zum Zitat Belle SH, Berk PD, Courcoulas AP, et al. Safety and efficacy of bariatric surgery: longitudinal assessment of bariatric surgery. Surg Obes Relat Dis. 2007;3(2):116–126.CrossRefPubMedPubMedCentral Belle SH, Berk PD, Courcoulas AP, et al. Safety and efficacy of bariatric surgery: longitudinal assessment of bariatric surgery. Surg Obes Relat Dis. 2007;3(2):116–126.CrossRefPubMedPubMedCentral
6.
Zurück zum Zitat Smith MD, Patterson E, Wahed AS, et al. Thirty-day mortality after bariatric surgery: independently adjudicated causes of death in the longitudinal assessment of bariatric surgery. Obes Surg. 2011;21(11):1687–1692.CrossRefPubMedPubMedCentral Smith MD, Patterson E, Wahed AS, et al. Thirty-day mortality after bariatric surgery: independently adjudicated causes of death in the longitudinal assessment of bariatric surgery. Obes Surg. 2011;21(11):1687–1692.CrossRefPubMedPubMedCentral
7.
Zurück zum Zitat Morino M, Toppino M, Forestieri P, Angrisani L, Allaix ME, Scopinaro N. Mortality after bariatric surgery: analysis of 13,871 morbidly obese patients from a national registry. Ann Surg. 2007;246(6):1002–1007; discussion 1007–1009.CrossRefPubMed Morino M, Toppino M, Forestieri P, Angrisani L, Allaix ME, Scopinaro N. Mortality after bariatric surgery: analysis of 13,871 morbidly obese patients from a national registry. Ann Surg. 2007;246(6):1002–1007; discussion 1007–1009.CrossRefPubMed
8.
Zurück zum Zitat Hutter MM, Schirmer BD, Jones DB, et al. First report from the American College of Surgeons Bariatric Surgery Center Network: laparoscopic sleeve gastrectomy has morbidity and effectiveness positioned between the band and the bypass. Ann Surg. 2011;254(3):410–420; discussion 420–412.CrossRefPubMedPubMedCentral Hutter MM, Schirmer BD, Jones DB, et al. First report from the American College of Surgeons Bariatric Surgery Center Network: laparoscopic sleeve gastrectomy has morbidity and effectiveness positioned between the band and the bypass. Ann Surg. 2011;254(3):410–420; discussion 420–412.CrossRefPubMedPubMedCentral
9.
Zurück zum Zitat Flum DR, Belle SH, King WC, et al. Perioperative safety in the longitudinal assessment of bariatric surgery. N Engl J Med. 2009;361(5):445–454.CrossRefPubMed Flum DR, Belle SH, King WC, et al. Perioperative safety in the longitudinal assessment of bariatric surgery. N Engl J Med. 2009;361(5):445–454.CrossRefPubMed
10.
Zurück zum Zitat Cottam D, Lord J, Dallal RM, et al. Medicolegal analysis of 100 malpractice claims against bariatric surgeons. Surg Obes Relat Dis. 2007;3(1):60–66; discussion 66–67.CrossRefPubMed Cottam D, Lord J, Dallal RM, et al. Medicolegal analysis of 100 malpractice claims against bariatric surgeons. Surg Obes Relat Dis. 2007;3(1):60–66; discussion 66–67.CrossRefPubMed
11.
Zurück zum Zitat Podnos YD, Jimenez JC, Wilson SE, Stevens CM, Nguyen NT. Complications after laparoscopic gastric bypass: a review of 3464 cases. Arch Surg. 2003;138(9):957–961.CrossRefPubMed Podnos YD, Jimenez JC, Wilson SE, Stevens CM, Nguyen NT. Complications after laparoscopic gastric bypass: a review of 3464 cases. Arch Surg. 2003;138(9):957–961.CrossRefPubMed
13.
Zurück zum Zitat Choudhry AJ, Haddad NN, Rivera M, et al. Medical malpractice in the management of small bowel obstruction: a 33-year review of case law. Surgery. 2016. Choudhry AJ, Haddad NN, Rivera M, et al. Medical malpractice in the management of small bowel obstruction: a 33-year review of case law. Surgery. 2016.
14.
Zurück zum Zitat Choudhry AJ, Anandalwar SP, Svider PF, Oliver JO, Eloy JA, Chokshi RJ. Uncovering malpractice in appendectomies: a review of 234 cases. J Gastrointest Surg. 2013;17(10):1796–1803.CrossRefPubMed Choudhry AJ, Anandalwar SP, Svider PF, Oliver JO, Eloy JA, Chokshi RJ. Uncovering malpractice in appendectomies: a review of 234 cases. J Gastrointest Surg. 2013;17(10):1796–1803.CrossRefPubMed
15.
Zurück zum Zitat Svider PF, Eloy JA, Folbe AJ, Carron MA, Zuliani GF, Shkoukani MA. Craniofacial surgery and adverse outcomes: an inquiry into medical negligence. Ann Otol Rhinol Laryngol. 2015;124(7):515–522.CrossRefPubMed Svider PF, Eloy JA, Folbe AJ, Carron MA, Zuliani GF, Shkoukani MA. Craniofacial surgery and adverse outcomes: an inquiry into medical negligence. Ann Otol Rhinol Laryngol. 2015;124(7):515–522.CrossRefPubMed
16.
Zurück zum Zitat Svider PF, Vidal GP, Zumba O, et al. Adverse events in carotid endarterectomy from a medicolegal perspective. Vasc Endovascular Surg. 2014;48(5–6):425–429.CrossRefPubMed Svider PF, Vidal GP, Zumba O, et al. Adverse events in carotid endarterectomy from a medicolegal perspective. Vasc Endovascular Surg. 2014;48(5–6):425–429.CrossRefPubMed
17.
Zurück zum Zitat Colaco M, Sandberg J, Badlani G. Influencing factors leading to malpractice litigation in radical prostatectomy. J Urol. 2014;191(6):1770–1775.CrossRefPubMed Colaco M, Sandberg J, Badlani G. Influencing factors leading to malpractice litigation in radical prostatectomy. J Urol. 2014;191(6):1770–1775.CrossRefPubMed
18.
Zurück zum Zitat Lekovic GP, Harrington TR. Litigation of missed cervical spine injuries in patients presenting with blunt traumatic injury. Neurosurgery. 2007;60(3):516–522; discussion 522–513.CrossRefPubMed Lekovic GP, Harrington TR. Litigation of missed cervical spine injuries in patients presenting with blunt traumatic injury. Neurosurgery. 2007;60(3):516–522; discussion 522–513.CrossRefPubMed
21.
Zurück zum Zitat Fullum TM, Aluka KJ, Turner PL. Decreasing anastomotic and staple line leaks after laparoscopic Roux-en-Y gastric bypass. Surg Endosc. 2009;23(6):1403–1408.CrossRefPubMed Fullum TM, Aluka KJ, Turner PL. Decreasing anastomotic and staple line leaks after laparoscopic Roux-en-Y gastric bypass. Surg Endosc. 2009;23(6):1403–1408.CrossRefPubMed
22.
Zurück zum Zitat Fernandez AZ, Jr., DeMaria EJ, Tichansky DS, et al. Experience with over 3,000 open and laparoscopic bariatric procedures: multivariate analysis of factors related to leak and resultant mortality. Surg Endosc. 2004;18(2):193–197.CrossRefPubMed Fernandez AZ, Jr., DeMaria EJ, Tichansky DS, et al. Experience with over 3,000 open and laparoscopic bariatric procedures: multivariate analysis of factors related to leak and resultant mortality. Surg Endosc. 2004;18(2):193–197.CrossRefPubMed
23.
Zurück zum Zitat Carrasquilla C, English WJ, Esposito P, Gianos J. Total stapled, total intra-abdominal (TSTI) laparoscopic Roux-en-Y gastric bypass: one leak in 1000 cases. Obes Surg. 2004;14(5):613–617.CrossRefPubMed Carrasquilla C, English WJ, Esposito P, Gianos J. Total stapled, total intra-abdominal (TSTI) laparoscopic Roux-en-Y gastric bypass: one leak in 1000 cases. Obes Surg. 2004;14(5):613–617.CrossRefPubMed
24.
Zurück zum Zitat Jacobsen HJ, Nergard BJ, Leifsson BG, et al. Management of suspected anastomotic leak after bariatric laparoscopic Roux-en-y gastric bypass. Br J Surg. 2014;101(4):417–423.CrossRefPubMedPubMedCentral Jacobsen HJ, Nergard BJ, Leifsson BG, et al. Management of suspected anastomotic leak after bariatric laparoscopic Roux-en-y gastric bypass. Br J Surg. 2014;101(4):417–423.CrossRefPubMedPubMedCentral
25.
Zurück zum Zitat Aurora AR, Khaitan L, Saber AA. Sleeve gastrectomy and the risk of leak: a systematic analysis of 4,888 patients. Surg Endosc. 2012;26(6):1509–1515.CrossRefPubMed Aurora AR, Khaitan L, Saber AA. Sleeve gastrectomy and the risk of leak: a systematic analysis of 4,888 patients. Surg Endosc. 2012;26(6):1509–1515.CrossRefPubMed
26.
Zurück zum Zitat Gastrointestinal surgery for severe obesity: National Institutes of Health Consensus Development Conference Statement. Am J Clin Nutr. 1992;55(2 Suppl):615S-619S. Gastrointestinal surgery for severe obesity: National Institutes of Health Consensus Development Conference Statement. Am J Clin Nutr. 1992;55(2 Suppl):615S-619S.
27.
Zurück zum Zitat Boothman RC, Imhoff SJ, Campbell DA, Jr. Nurturing a culture of patient safety and achieving lower malpractice risk through disclosure: lessons learned and future directions. Front Health Serv Manage. 2012;28(3):13–28.PubMed Boothman RC, Imhoff SJ, Campbell DA, Jr. Nurturing a culture of patient safety and achieving lower malpractice risk through disclosure: lessons learned and future directions. Front Health Serv Manage. 2012;28(3):13–28.PubMed
28.
Zurück zum Zitat Mahmoud M, Maasher A, Al Hadad M, Salim E, Nimeri AA. Laparoscopic Roux En Y esophago-jejunostomy for chronic leak/fistula after laparoscopic sleeve gastrectomy. Obes Surg. 2016;26(3):679–682.CrossRefPubMed Mahmoud M, Maasher A, Al Hadad M, Salim E, Nimeri AA. Laparoscopic Roux En Y esophago-jejunostomy for chronic leak/fistula after laparoscopic sleeve gastrectomy. Obes Surg. 2016;26(3):679–682.CrossRefPubMed
29.
Zurück zum Zitat Guetta O, Ovnat A, Shaked G, Czeiger D, Sebbag G. Analysis of morbidity data of 308 cases of laparoscopic sleeve gastrectomy—the Soroka experience. Obes Surg. 2015;25(11):2100–2105.CrossRefPubMed Guetta O, Ovnat A, Shaked G, Czeiger D, Sebbag G. Analysis of morbidity data of 308 cases of laparoscopic sleeve gastrectomy—the Soroka experience. Obes Surg. 2015;25(11):2100–2105.CrossRefPubMed
30.
Zurück zum Zitat Zellmer JD, Mathiason MA, Kallies KJ, Kothari SN. Is laparoscopic sleeve gastrectomy a lower risk bariatric procedure compared with laparoscopic Roux-en-Y gastric bypass? A meta-analysis. Am J Surg. 2014;208(6):903–910; discussion 909–910. Zellmer JD, Mathiason MA, Kallies KJ, Kothari SN. Is laparoscopic sleeve gastrectomy a lower risk bariatric procedure compared with laparoscopic Roux-en-Y gastric bypass? A meta-analysis. Am J Surg. 2014;208(6):903–910; discussion 909–910.
31.
Zurück zum Zitat Tuchtan L, Kassir R, Sastre B, Gouillat C, Piercecchi-Marti MD, Bartoli C. Medico-legal analysis of legal complaints in bariatric surgery: a 15-year retrospective study. Surg Obes Relat Dis. 2015. Tuchtan L, Kassir R, Sastre B, Gouillat C, Piercecchi-Marti MD, Bartoli C. Medico-legal analysis of legal complaints in bariatric surgery: a 15-year retrospective study. Surg Obes Relat Dis. 2015.
32.
Zurück zum Zitat Levinson W, Hudak P, Tricco AC. A systematic review of surgeon-patient communication: strengths and opportunities for improvement. Patient Educ Couns. 2013;93(1):3–17.CrossRefPubMed Levinson W, Hudak P, Tricco AC. A systematic review of surgeon-patient communication: strengths and opportunities for improvement. Patient Educ Couns. 2013;93(1):3–17.CrossRefPubMed
33.
Zurück zum Zitat Adamson TE, Baldwin DC, Jr., Sheehan TJ, Oppenberg AA. Characteristics of surgeons with high and low malpractice claims rates. West J Med. 1997;166(1):37–44.PubMedPubMedCentral Adamson TE, Baldwin DC, Jr., Sheehan TJ, Oppenberg AA. Characteristics of surgeons with high and low malpractice claims rates. West J Med. 1997;166(1):37–44.PubMedPubMedCentral
34.
Zurück zum Zitat Levinson W. Physician-patient communication. A key to malpractice prevention. JAMA. 1994;272(20):1619–1620.CrossRefPubMed Levinson W. Physician-patient communication. A key to malpractice prevention. JAMA. 1994;272(20):1619–1620.CrossRefPubMed
35.
Zurück zum Zitat Svider PF, Husain Q, Kovalerchik O, et al. Determining legal responsibility in otolaryngology: a review of 44 trials since 2008. Am J Otolaryngol. 2013;34(6):699–705.CrossRefPubMed Svider PF, Husain Q, Kovalerchik O, et al. Determining legal responsibility in otolaryngology: a review of 44 trials since 2008. Am J Otolaryngol. 2013;34(6):699–705.CrossRefPubMed
36.
Zurück zum Zitat Svider PF, Sunaryo PL, Keeley BR, Kovalerchik O, Mauro AC, Eloy JA. Characterizing liability for cranial nerve injuries: a detailed analysis of 209 malpractice trials. Laryngoscope. 2013;123(5):1156–1162.CrossRefPubMed Svider PF, Sunaryo PL, Keeley BR, Kovalerchik O, Mauro AC, Eloy JA. Characterizing liability for cranial nerve injuries: a detailed analysis of 209 malpractice trials. Laryngoscope. 2013;123(5):1156–1162.CrossRefPubMed
Metadaten
Titel
Medical Malpractice in Bariatric Surgery: a Review of 140 Medicolegal Claims
verfasst von
Asad J. Choudhry
Nadeem N. Haddad
Matthew Martin
Cornelius A. Thiels
Elizabeth B. Habermann
Martin D. Zielinski
Publikationsdatum
11.10.2016
Verlag
Springer US
Erschienen in
Journal of Gastrointestinal Surgery / Ausgabe 1/2017
Print ISSN: 1091-255X
Elektronische ISSN: 1873-4626
DOI
https://doi.org/10.1007/s11605-016-3273-1

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