A Simplified and Validated Risk Score of Malpractice Litigation in Minimally Invasive Surgery (MIS)

Alberto Raul Ferreres, MD, PhD, FACS, hon, Rosana Trapani, MD, Alberto Rancati, MD, Julieta Camelione, MD. University of Buenos Aires

Introduction: The adoption of minimally invasive procedures have increased the incidence of  malpractice litigation claims due to complications and unfavorable outcomes. In that sense the rising number of biliary duct injuries due to laparoscopic cholecystectomy represents an example. Besides, the due standard of care and the accomplishment of a training curve to become an expert represent additional features. All these factors contribute to the epidemics of surgical malpractice litigation worldwide and in that sense our country is no exception. The use of risk predictors may be useful as a tool in risk management and patient safety policies. Our objective was to design and validate a simplified predictor score of malpractice litigation in minimally invasive surgery

Methods and Procedures: A prediction score (PIDOM) was designed taking into account the following variables: Patient age (under 40/ 40-70/ elder than 50), patient-physician Interaction (standard/ below standard), Disease (benign/malignant), Outcomes (as planned/ differs from planned) and Medical records quality(fair/good) and a predictive score was organized accordingly: high risk for litigation (8-10), medium risk (5-7) and low risk (1-4). In order to validate the risk score, 800 randomly medical records corresponding to minimally invasive procedures from 5 institutions performed between june 2012 and june 2013 were examined. After the assessment and risk stratification were completed, a request was submitted to the Courts and to the five insurance companies in order to know the incidence of claims sued in the 2 years following the surgical procedures. The statistical analysis was performed with the Anova and t tests.

Results: The procedures included the following: laparoscopic cholecystectomy: 495 (61.87%); appendectomy 95 (11.87%); hernia repair 61 (7.62%); colectomy 122 (15.25%) and splenectomy 27 (3.37 %). The assessment of the 800 medical records was as follows: 600 (75%) were considered as low risk; 159 (19.87%), medium risk and 41 (5.12%), high risk. The incidence of claims was the following: low risk group: 4/600 (0.33%), medium risk: 48/159 (30.18%) and high risk: 25 (60.97%). The most frequent cause were biliary duct injury (28, 36%), and visceral injury (13, 16.88%). Results were statistically significant.

Conclusions:The PIDOM risk score for malpractice litigation after MIS may play a role and serve as a useful aid tool in risk management. It may serve to identify high risk patients or problematical situations which may warrant quick and early interventions to prevent malpractice litigation in this field.

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