The impact of system and diagnostic errors for medical litigation outcomes in orthopedic surgery |
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| Institution: | 1. Department of Orthopedic Surgery, Miyamoto Orthopedic Hospital, Okayama, Japan;2. Systematic Review Workshop Peer Support Group (SRWS-PSG), Osaka, Japan;3. Shimane University Hospital, General Medicine Center, Shimane, Japan;4. Harvard Medical School, Master of Healthcare Quality and Patient Safety, Boston, USA;5. Department of Obstetrics & Gynecology, Yodogawa Christian Hospital, Osaka, Japan;6. Department of Orthopaedic Surgery and Traumatology, Kawasaki Medical School General Medical Center, Okayama, Japan;7. Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama, Japan;1. Istanbul Goztepe Prof.Dr.Suleyman Yalcin City Hospital, Department of Orthopaedics, Istanbul, Turkey;2. University of Health Sciences, Ümraniye Education and Research Hospital, Department of Pediatric Rheumatology, Istanbul, Turkey;3. Istanbul Afiyet Hospital, Department of Orthopaedics, Istanbul, Turkey;4. Istanbul Goztepe Prof.Dr.Suleyman Yalcin City Hospital, Department of Pathology, Istanbul, Turkey;5. Istanbul Goztepe Prof.Dr.Suleyman Yalcin City Hospital, Department of Radiology, Istanbul, Turkey;6. University of Cincinnati Medical Center, Department of Orthopedic Surgery, Cincinnati, OH, United States;1. Department of Internal Medicine, Mito Clinical Education and Training Center, University of Tsukuba Hospital, Mito Kyodo General Hospital, 3-2-7 Miya-Machi, Mito, Ibaraki, 310-0015, Japan;2. Department of Orthopedic Surgery, National Hospital Organization Mito Medical Center, 280 Sakuranosato, Ibarakimachi, Ibaraki, 311-3193, Japan;3. Baseball and Sports Clinic, 2-228-1 Kosugi, Park city Musashikosugi the Garden Towers West 1st Floor W4, Nakahara-ward, Kawasaki-city, Kanagawa, 211-0063, Japan;4. Department of Orthopaedic Surgery and Sports Medicine, Mito Clinical Education and Training Center, University of Tsukuba Hospital, Mito Kyodo General Hospital, 3-2-7 Miya-Machi, Mito, Ibaraki, 310-0015, Japan;5. Department of Radiology, Mito Clinical Education and Training Center, University of Tsukuba Hospital, Mito Kyodo General Hospital. 3-2-7 Miya-Machi, Mito, Ibaraki, 310-0015, Japan;1. Department of Plastic Surgery, Chiba Children''s Hospital, 579-1, Heta-cho, Midori-ku, Chiba-city, Chiba, Japan;2. Department of Plastic, Reconstructive, and Aesthetic Surgery, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chuo-ku, Chiba-city, Chiba, Japan;1. Department of Orthopaedic Surgery, National Hospital Organization Tokyo Medical Center, 2-5-1 Higashigaoka, Meguro-ku, Tokyo 152-8902, Japan;2. Department of Orthopaedic Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo 173-8605, Japan;3. Department of Orthopaedic Surgery, Juntendo University School of Medicine, 1-5-29 Yushima, Bunkyo-ku, Tokyo 113-0034, Japan;4. Department of Rehabilitation, Teikyo University School of Medicine, 2-11-1, Kaga, Itabashi-ku, Tokyo 173-8605, Japan;5. Department of Palliative Medicine, Saitama Medical University, 38 Morohongo Moroyamamachi, Iruma-gun, Saitama 350-0495, Japan;6. Department of Rehabilitation, Kobe University School of Medicine, 7-5-2 Kusunokicho Kobe Chuo-ku, Hyogo 650-0017, Japan;7. Department of Orthopaedic Surgery, Bell Land General Hospital, 500-3 Higashiyama, Naka-ku, Sakai, Osaka 599-8247, Japan;8. Department of Orthopaedic Surgery, NTT Medical Center Tokyo, 5-9-22 Higashigotanda, Shinagawa-ku, Tokyo 141-8625, Japan;9. Towa Hospital, 4-7-10 Towa, Adachi-ku, Tokyo 120-0003, Japan;1. Department of Orthopaedic Surgery, Eastern Chiba Medical Center, Togane, Chiba, Japan;2. Department of General Medical Science, Graduate School of Medicine, Chiba University, Chiba-city, Chiba, Japan;3. Department of Orthopaedic Surgery, Toho University Sakura Medical Center, Sakura, Chiba, Japan;4. Department of Orthopaedic Surgery, University of Tsukuba, Tsukuba, Ibaraki, Japan;5. Department of Orthopaedic Surgery, Kubota Orthopaedic Clinic, Katori, Chiba, Japan;6. Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba-city, Chiba, Japan |
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| Abstract: | BackgroundMedical litigation resulting from medical errors has a negative impact on health economics for both patients and medical practitioners. In medical litigation involving orthopedic surgeons, we aimed to identify factors contributing to plaintiff victory (orthopedic surgeon loss) through a comprehensive assessment.MethodsThis retrospective study included 166 litigation claims against orthopedic surgeons using a litigation database in Japan. We evaluated the sex and age of the patient (plaintiff), initial diagnosis, diagnostic error, system error, the time and place of each claim that led to malpractice litigation, the institution's size, and clinical outcomes. The main outcome was the litigation outcome (acceptance or rejection) in the final judgment. Acceptance meant that the orthopedic surgeon lost the malpractice lawsuit. We conducted multivariable logistic regression analyses to examine the association of factors with an accepted claim.ResultsThe median age of the patients was 42 years, and 65.7% were male. The litigation outcome of 85 (51.2%) claims was acceptance. The adjusted median indemnity paid was $151,818. The multivariable analysis showed that diagnostic error, system error, sequelae, inadequate medical procedure, and follow-up observation were significantly associated with the orthopedic surgeon losing the lawsuit. In particular, claims involving diagnostic errors were more likely to be acceptance claims, in which the orthopedic surgeon lost (adjusted odds ratio 16.7, 95% confidence intervals: 4.7 to 58.0, p < 0.001). All of the claims in which the orthopedic surgeon lost were associated with a diagnostic or system error, with the most common one being system error.ConclusionsSystem errors and diagnostic errors were significantly associated with acceptance claims (orthopedic surgeon losses). Since these are modifiable factors, it is necessary to take measures not only for individual physicians but also for the overall medical management system to enhance patient safety and reduce the litigation risk of orthopedic surgeons. |
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