The AAPS 101st Annual Meeting

Understanding Factors Associated with Paid Malpractice Claims in Plastic Surgery

Austin C Remington MD1, Adam Schaffer MD, MPH2, 3, Geoffrey E Hespe MD1, Carlos J Yugar MPH2, Rami Sherif MD1, Christian J Vercler MD1

1 Section of Plastic Surgery, University of Michigan. Ann Arbor, MI. 2 CRICO / The Risk Management Foundation of the Harvard Medical Institutions.

3 Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA.

Background

•Plastic surgeons have an approximately 15% risk of being named in a malpractice suit each year

•Fear of facing malpractice can negatively affect practice patterns and surgeon wellbeing

•Current literature is limited in the number of claims evaluated and the availability of variables influencing these cases

•The goal of this study was to contribute to improving patient care and address preventable causes of malpractice litigation

Methods

•Data was obtained through a source of malpractice claims called Candello, including 30% of both paid and unpaid claims in the U.S.

•Retrospective analysis – 2009 to 2018

•Variables – demographics, allegation category, contributing factors, clinical severity, care setting, major injury category, procedure involved, case outcome, and indemnity payment

•A multivariable logistic regression was developed with the case result (paid or unpaid settlement) as the primary outcome variable

Results

• 2,674 malpractice cases identified between 2009 and 2018

• The majority occurred in the outpatient setting (87.1%)

• 26.8% of claims were paid

• Clinical severity was determined to be high in 8.6% of cases

• Emotional trauma was the most frequently cited major injury category (20.9%)

• Major differences between procedure groups were not observed, with consistent severity of injury across categories (Table 1)

• Factors significantly predictive of and protective against a malpractice case closing with payment (Table 2)

•Predictive (red rows) – poor surgical technique, problems with communication among providers, inadequate informed consent, and deficient documentation

•Protective (green rows) – issue with technical performance in surgery resulting in a known complication and patient factors (e.g. seeking other surgeons due to dissatisfaction with care or non-adherence)

Conclusions

•Both the financial and clinical severity of malpractice claims in plastic surgery are relatively low

•No substantive differences in liability risk were noted between different procedure groups

•Multiple factors were found to be associated with a malpractice case closing with an indemnity payment

•These data highlight the importance of the informed consent process and managing expectations in the clinical care of surgical patients

The AAPS 101st Annual Meeting

Understanding Factors Associated With Paid Malpractice Claims In Plastic Surgery

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