TY - JOUR
T1 - Litigation patterns in inguinal hernia surgery
T2 - a 25 year review
AU - Grayson, Cary T.
AU - Criman, Erik T.
AU - Cefalu, Lindsay M.
AU - Roedel, Erik Q.
AU - Hong, Steven S.
AU - Yheulon, Christopher G.
N1 - Funding Information:
The Westlaw database (West Publishing Co, St. Paul, MN) was queried for US civil trials conducted in the United States involving claims of medical malpractice in inguinal hernia surgery between 1991 and 2016. Verdicts and formal settlements published by 14 judicial sources are published in the database and encompass cases from all 50 states and the District of Columbia. The database does not include cases dropped before reaching a court docket. Sixty-seven case summaries were obtained using the search terms “inguinal hernia” OR “inguinal herniorrhaphy” OR “inguinal hernioplasty.” The Westlaw database is based on publicly available records. In many cases, patient and physician identity were included in the source material available from Westlaw, although they were de-identified in our reporting. 12 Of these, 46 met criteria for inclusion in this study. Cases were included if a physician was named as a defendant, the case related to that physician's therapeutic intervention on inguinal hernia, and the injuries were alleged to result from that intervention. Cases that alleged harm not directly related to inguinal hernia surgery were excluded. Data were extracted and analyzed using Microsoft Excel (Microsoft Corp, Redmond, Washington). The data collected included patient age and gender, outcomes of the cases and indemnities, type of injury, allegations, and procedure type. Other pertinent case details collected were pediatric, bilaterality, surgery for recurrence, and presence of incarceration or strangulation at the time of surgery. Case reports were reviewed by the panel of authors as a group and consensus was reached. A Fisher's exact test was completed to determine which variables predicted a favorable or unfavorable outcome for the defendant. Statistical testing was not performed for categories with 10 or fewer data points. For plaintiff verdicts and settlements, the Mann–Whitney U test was used to determine if any of these variables made a significant difference in the amount of the award. This study was exempt from the local review by the Tripler Army Medical Center Department of Clinical Investigation approval.
Publisher Copyright:
© 2018
PY - 2018/12
Y1 - 2018/12
N2 - Background: Inguinal herniorraphyis among the most common procedures performed by general surgeons, but risk factors for litigation related to this surgery are poorly defined. Methods: Cases were retrieved by searching the Westlaw database from 1991 through 2016 using the search terms “inguinal hernia” OR “inguinal herniorrhaphy” OR “inguinal hernioplasty” and “medical malpractice.” Data were compiled on the demographics of the patient, operative case details, nature of injury, legal allegations, verdicts, and indemnities. Results: Forty-six cases met inclusion criteria and were selected for review. Verdicts for the defendant predominated (67%). The average plaintiff's monetary award for a plaintiff verdict or settlement was $1.21 million (median $500,000). The most frequent legal argument was improper performance (n = 35, 76%), followed by failure of informed consent (n = 14, 30%). The most common complications were nerve/chronic pain (n = 20, 45%) and testicular damage (n = 10, 23%). No association was discovered between case outcome and patient gender (P = 0.231) or age (P = 0.899). Case outcome was not different between open and laparoscopic repairs (P = 0.722). Patient mortality was not associated with case outcome (P = 0.311). There was no chronological trend in case outcome or award amount. Settlement award amounts were not significantly different than plaintiff awards (P = 0.390). Conclusions: Successful litigation after inguinal hernia surgery was relatively infrequent—only 21.7%—with an additional 10.9% resulting in settlement awards. Case outcome in litigation for hernia surgery was not predicted by patient demographics, type of procedure, or type of complication in this data set.
AB - Background: Inguinal herniorraphyis among the most common procedures performed by general surgeons, but risk factors for litigation related to this surgery are poorly defined. Methods: Cases were retrieved by searching the Westlaw database from 1991 through 2016 using the search terms “inguinal hernia” OR “inguinal herniorrhaphy” OR “inguinal hernioplasty” and “medical malpractice.” Data were compiled on the demographics of the patient, operative case details, nature of injury, legal allegations, verdicts, and indemnities. Results: Forty-six cases met inclusion criteria and were selected for review. Verdicts for the defendant predominated (67%). The average plaintiff's monetary award for a plaintiff verdict or settlement was $1.21 million (median $500,000). The most frequent legal argument was improper performance (n = 35, 76%), followed by failure of informed consent (n = 14, 30%). The most common complications were nerve/chronic pain (n = 20, 45%) and testicular damage (n = 10, 23%). No association was discovered between case outcome and patient gender (P = 0.231) or age (P = 0.899). Case outcome was not different between open and laparoscopic repairs (P = 0.722). Patient mortality was not associated with case outcome (P = 0.311). There was no chronological trend in case outcome or award amount. Settlement award amounts were not significantly different than plaintiff awards (P = 0.390). Conclusions: Successful litigation after inguinal hernia surgery was relatively infrequent—only 21.7%—with an additional 10.9% resulting in settlement awards. Case outcome in litigation for hernia surgery was not predicted by patient demographics, type of procedure, or type of complication in this data set.
KW - Inguinal hernia
KW - Litigation
KW - Malpractice
UR - http://www.scopus.com/inward/record.url?scp=85049803154&partnerID=8YFLogxK
U2 - 10.1016/j.jss.2018.06.049
DO - 10.1016/j.jss.2018.06.049
M3 - Article
C2 - 30463728
AN - SCOPUS:85049803154
SN - 0022-4804
VL - 232
SP - 266
EP - 270
JO - Journal of Surgical Research
JF - Journal of Surgical Research
ER -