Abstract
Background
There has been recent interest in the delayed and nonoperative management of appendicitis. The present study assessed the causes and costs of litigation against surgeons following emergency appendectomy, with an emphasis on claims relating to preoperative management.
Materials and methods
Data were obtained from the English NHS Litigation Authority for claims relevant to appendectomy between 2002 and 2011. Two authors independently extracted data and classified it against predetermined criteria.
Results
Successful litigation occurred in 66 % of closed cases (147/223) with a total payout of £8.1 million. There were 24 claims against organizational operating room delays (9 % of total) and 27 against delayed diagnosis (10 %), with respective success rates of 70 and 68 %. From 21 claims relating to damage to fertility, nine were due to either delayed diagnosis or organizational operating room delays. Misdiagnosis was the second most common cause for litigation (16 %), but it had the lowest likelihood of success (49 %). Faulty surgical technique was the most common reason for litigation (39 %), with a 70 % likelihood of success. Of eight claims related to fatality, one was due to unacceptable preoperative delay leading to preventable perforated appendicitis. The overall highest median payouts were for claims of damage to fertility (£52,384), operating list delays (£44,716), and delayed diagnosis (£42,292).
Conclusions
There were significant medicolegal risks surrounding delays related to access to operating lists and diagnosis. Whereas future evidence regarding the safety of delayed appendectomy may provide scientific defense against these claims, the present study provides evidence of the current medicolegal risk to surgeons following delayed treatment of appendicitis.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Hospital Episode Statistics (2010) Total procedures and interventions. http://www.hesonline.nhs.uk/Ease/servlet/ContentServer?siteID=1937&categoryID=210. Accessed 28 July 2011
Buckius MT, McGrath B, Monk J et al (2012) Changing epidemiology of acute appendicitis in the United States: study period 1993–2008. J Surg Res 175:185–190
Flum DR, Morris A, Koepsell T et al (2001) Has misdiagnosis of appendicitis decreased over time? A population-based analysis. JAMA 286:1748–1753
Katkhouda N, Mason RJ, Towfigh S et al (2005) Laparoscopic versus open appendectomy: a prospective randomized double-blind study. Ann Surg 242:439–448
Simpson J, Samaraweera AP, Sara RK et al (2008) Acute appendicitis—a benign disease? Ann R Coll Surg Engl 90:313–316
Cullinane M, Grat AJG, Hargraves CMK et al (2003) The 2003 Report of the National Confidential Enquiry into Patient Outcome and Death. NCEPOD, London
Toll EC, Davis CR (2010) More trainees and less operative exposure: a quantitative analysis of training opportunities for junior surgical trainees. Ann R Coll Surg Engl 92:170–173
National Health Service Litigation Authority (2011) Factsheet 2: financial information. http://www.nhsla.com/NR/rdonlyres/465D7ABD-239F-4273-A01E-C0CED557453D/0/NHSLAFactsheet2financialinformation201011.doc. Accessed 27 July 2011
Alkhaffaf B, Decadt B (2010) 15 years of litigation following laparoscopic cholecystectomy in England. Ann Surg 251:682–685
Gossage JA, Forshaw MJ (2010) Prevalence and outcome of litigation claims in England after laparoscopic cholecystectomy. Int J Clin Pract 64:1832–1835
Markides GA, Subar D, Al-Khaffaf H (2008) Litigation claims in vascular surgery in the United Kingdom’s NHS. Eur J Vasc Endovasc Surg 36:452–457
Pawa N, Ypsilantis E (2009) Inguinal hernia repair—trends in litigation. Ann R Coll Surg Engl 91:180
Rusnak RA, Borer JM, Fastow JS (1994) Misdiagnosis of acute appendicitis: common features discovered in cases after litigation. Am J Emerg Med 12:397–402
Stahlfeld K, Hower J, Homitsky S et al (2007) Is acute appendicitis a surgical emergency? Am Surg 73:626–629 discussion 629–630
Ditillo MF, Dziura JD, Rabinovici R (2006) Is it safe to delay appendectomy in adults with acute appendicitis? Ann Surg 244:656–660
Varadhan KK, Neal KR, Lobo DN (2012) Safety and efficacy of antibiotics compared with appendicectomy for treatment of uncomplicated acute appendicitis: meta-analysis of randomised controlled trials. Br Med J 344:e2156
Livingston EH, Woodward WA, Sarosi GA et al (2007) Disconnect between incidence of nonperforated and perforated appendicitis: implications for pathophysiology and management. Ann Surg 245:886–892
Temple CL, Huchcroft SA, Temple WJ (1995) The natural history of appendicitis in adults. A prospective study. Ann Surg 221:278–281
Busch M, Gutzwiller FS, Aellig S et al (2011) In-hospital delay increases the risk of perforation in adults with appendicitis. World J Surg 35:1626–1633
Jones GE, Kreckler S, Shah A et al (2012) Increased use of laparoscopy in acute right iliac fossa pain—is it good for patients? Colorectal Dis 14:237–242
Singh-Ranger D, Ogadegbe A (2010) Leucocyte count and oral temperature are a useful guide to selecting women with right iliac fossa pain for diagnostic laparoscopy. Ann R Coll Surg Engl 92:425–428
Wong K, Duncan T, Pearson A (2007) Unsupervised laparoscopic appendicectomy by surgical trainees is safe and time-effective. Asian J Surg 30:161–166
Scarborough JE, Bennett KM, Pappas TN (2012) Defining the impact of resident participation on outcomes after appendectomy. Ann Surg 255:577–582
Graat LJ, Bosma E, Roukema JA et al (2012) Appendectomy by residents is safe and not associated with a higher incidence of complications: a retrospective cohort study. Ann Surg 255:715–719
Myers E, Kavanagh DO, Ghous H et al (2010) The impact of evolving management strategies on negative appendicectomy rate. Colorectal Dis 12:817–821
Rettenbacher T, Hollerweger A, Gritzmann N et al (2002) Appendicitis: should diagnostic imaging be performed if the clinical presentation is highly suggestive of the disease? Gastroenterology 123:992–998
Bhangu A, Richardson C, Winter H et al (2010) Value of initial radiological investigations in patients admitted to hospital with appendicitis, acute gallbladder disease or acute pancreatitis. Emerg Med J 27:754–757
Goodwin H (2000) Litigation and surgical practice in the UK. Br J Surg 87:977–979
Sauerland S, Jaschinski T, Neugebauer EA (2010) Laparoscopic versus open surgery for suspected appendicitis. Cochrane Database Syst Rev. CD001546. doi:10.1002/14651858.CD001546.pub3
Hussain A, Mahmood H, Nicholls J et al (2008) Prevention of intra-abdominal abscess following laparoscopic appendicectomy for perforated appendicitis: a prospective study. Int J Surg 6:374–377
Bennett J, Boddy A, Rhodes M (2007) Choice of approach for appendicectomy: a meta-analysis of open versus laparoscopic appendicectomy. Surg Laparosc Endosc Percutan Tech 17:245–255
Studdert DM, Thomas EJ, Burstin HR et al (2000) Negligent care and malpractice claiming behavior in Utah and Colorado. Med Care 38:250–260
Vincent C, Young M, Phillips A (1994) Why do people sue doctors? A study of patients and relatives taking legal action. Lancet 343:1609–1613
Macgregor JM, Sticca R (2010) General surgery residents’ views on work hours regulations. J Surg Educ 67:376–380
Acknowledgments
The authors are grateful to the NHS Litigation Authority for providing the data for this study.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Mosedale, T., Nepogodiev, D., Fitzgerald, J.E.F. et al. Causes and Costs of a Decade of Litigation Following Emergency Appendectomy in England. World J Surg 37, 1851–1858 (2013). https://doi.org/10.1007/s00268-013-1907-y
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00268-013-1907-y