Malpractice claims in spine surgery in Germany: a 5-year analysis

STUDY DESIGN

Retrospective analysis of anonymized malpractice claims.

SUMMARY OF BACKGROUND DATA

Spine surgery is considered a high-risk specialty with regards to malpractice claims. However, limited data is available for Germany. We analyzed the rate, subject, and legal outcome of malpractice claims faced by spine surgeons in one of the largest Medical Council coverage areas in Germany, representing 60,000 physicians and a population of 10 million.

METHODS

Analysis of all malpractice claims regarding spinal surgeries completed by the Review Board of the North Rhine Medical Council (NRMC) from 2012 to 2016. Claim merit, content, and actual treatment errors were reviewed. Severity of damage was graded from negligible (1) to death (6).

RESULTS

A total of 8,381 malpractice cases were reviewed by the NRMC from 2012 to 2016. Four percent (340 cases: 181 females, 159 males) pertained to patients undergoing spinal surgery with 94.7% of patients undergoing inhospital treatment and 5.3% as outpatients. Malpractice claims most frequently involved neurosurgery (48.5%) and orthopedic surgery (37.6%). Trauma surgery was involved in 9.1% and other specialties in 4.8%. Actual treatment errors were found in 89 of 340 cases (26.2%).Of those, 81 resulted in treatment-associated health impairment. Negligible and/or temporary impairment was found in 49.3%. Negligible to moderate but permanent damage was observed in 39.5%. Nine patients suffered severe permanent damage or death (11.1%). The treated diagnosis was degenerative disc disease in 34 patients (41.9%), spinal canal stenosis in 13 (16%), vertebral body fractures in 10 (12.3%), spondylolisthesis in 6 (7.4%), and other diagnoses accounting for the remaining 18 (22.2%). Errors involved actual surgical treatment in 40.7%, surgical indication and preoperative workup in 28.4%, postoperative treatment in 25.9%, and patient consent in 4.9%.

CONCLUSIONS

Spinal surgery claims account for 4% of all claims reviewed by the NRMC in the 5-year period from 2012 to 2016. Eighty-nine (26.2%) were deemed justified. The majority of treatment errors (59.3%) occurred during workup, indication and consent, or during postoperative care. Errors during actual surgery were responsible for 40.7% of all treatment-associated damages. Understanding the distribution and content of claims is key to improving patient satisfaction not only by honing surgical skills, but also by improving pre- and postoperative communication and care.

[Medication errors in a neonatal unit: One of the main adverse events]

INTRODUCTION

Neonatal units are one of the hospital areas most exposed to the committing of treatment errors. A medication error (ME) is defined as the avoidable incident secondary to drug misuse that causes or may cause harm to the patient. The aim of this paper is to present the incidence of ME (including feeding) reported in our neonatal unit and its characteristics and possible causal factors. A list of the strategies implemented for prevention is presented.

MATERIAL AND METHODS

An analysis was performed on the ME declared in a neonatal unit.

RESULTS

A total of 511 MEs have been reported over a period of seven years in the neonatal unit. The incidence in the critical care unit was 32.2 per 1000 hospital days or 20 per 100 patients, of which 0.22 per 1000 days had serious repercussions. The ME reported were, 39.5% prescribing errors, 68.1% administration errors, 0.6% were adverse drug reactions. Around two-thirds (65.4%) were produced by drugs, with 17% being intercepted. The large majority (89.4%) had no impact on the patient, but 0.6% caused permanent damage or death. Nurses reported 65.4% of MEs. The most commonly implicated causal factor was distraction (59%). Simple corrective action (alerts), and intermediate (protocols, clinical sessions and courses) and complex actions (causal analysis, monograph) were performed.

CONCLUSIONS

It is essential to determine the current state of ME, in order to establish preventive measures and, together with teamwork and good practices, promote a climate of safety.

Litigations in orthopedics and trauma surgery: reasons, dynamics, and profiles

BACKGROUND

In recent literature, the increasing number of medical litigations, both in terms of the number of cases being filed and the substantive costs associated with lawsuits, has been described. This study aims to provide an overview of the profile of litigation for orthopedic and trauma surgery to describe the differences and the development of the number of cases over time.

PATIENTS AND MATERIALS

A retrospective review of all litigations between 2000 and 2017 was conducted using the institutional legal database. The causes of litigation were documented and classified into seven major categories. In addition to plaintiff characteristics, the litigation outcomes and the differences between emergency and elective surgery were analyzed.

RESULTS

A total of 230 cases were evaluated. The mean age of the plaintiffs was 44.6 ± 20.1 years, and 56.8% were female. The main reasons for litigation were claimed inappropriate management (46.1%), misdiagnosis (22.6), and poor nursing care (8.3%). Significantly more litigations were filed against surgeons of the orthopedic subspecialty compared with trauma surgeons (78%; p ≤ 0.0001). There were significantly fewer litigations per 1000 cases filed overall in 2009-2017 (65% less; p = 0.003) than in 2000-2008.

CONCLUSION

Our results could not confirm the often-stated trend of having more litigations against orthopedic and trauma surgeons. Although the absolute numbers increased, the number of litigations per 1000 patients treated declined. Patients who underwent elective surgery were more likely to file complaints than emergency patients.

[Fatal complications after urological interventions-connection between error, damage and causality]

Case studies from the clinic outline the connection between error, damage and causality. If the three "categories" mentioned are to be affirmed, recourse claims of the payers and the patients or their relatives are enforced in practice.

[What holds the hospital together-A "fixation error" in terms of patient safety]

BACKGROUND

Fixation plasters are nowadays an important part of clinical care and the product range is adapted to the needs of patient care. A multifaceted selection is available.

AIM OF THE STUDY

To increase vigilance towards the supposedly low-threshold use of fixation plasters in patient care.

MATERIAL AND METHOD

This review is dedicated to the use of fixation plasters, mostly outside of their intended use on patients.

RESULTS

There are countless examples of how fixation plasters are used outside of their intended purpose and patient safety is often neglected. This can lead to an occult latex contamination. Devices repaired with makeshift fixation plasters also put patients at risk. From a hygienic point of view, adhesive residues from fixation plasters promote surface contamination of various materials or work surfaces.

DISCUSSION

The intended use of medical products is meaningful and prescribed by law. This serves to ensure patient and user safety. Further training is extremely important so that vigilant players in the healthcare sector can counteract sources of danger. This special attention can be trained in the "room of error", for example, and is one of the most important preventative measures to avoid errors occurring in the first place. Checking the use of fixation plasters in one's own working environment helps to minimize risks.

[We are obligated to exercise due diligence-but what does this look like in practice?]

Expert reports analyze medical malpractice in urology based on selected case studies and assess their medical and legal implications. Common sources of error include noncompliance with clinical guidelines, inadequate patient information, insufficient diagnostics, and a lack of interdisciplinary coordination. The cases include, among others, incorrect biopsy techniques, delayed stroke diagnoses, failure to communicate pathological findings, and problematic coercive measures in pediatric patients. The legal assessments highlight the importance of thorough documentation and effective patient communication in mitigating liability risks. In several cases, diagnostic errors result in a reversal of the burden of proof in favor of the patient. The expert report emphasizes the necessity of a structured, evidence-based, and interdisciplinary approach to minimize treatment errors and their consequences.