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The impact and prevention of systemic and diagnostic errors in surgical malpractice claims in Japan: a retrospective cohort study

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Abstract

The Surgical Patient Safety System (SURPASS) has been proven to improve patient outcomes. However, few studies have evaluated the details of litigation and its prevention in terms of systemic and diagnostic errors as potentially preventable problems. The present study explored factors associated with accepted claims (surgeon-loss). We retrospectively searched the national Japanese malpractice claims database between 1961 and 2017. Using multivariable logistic regression models, we assessed the association between medical malpractice variables (systemic and diagnostic errors, facility size, time, place, and clinical outcomes) and litigation outcomes (acceptance). We evaluated whether or not the factors associated with litigation could have been prevented with the SURPASS checklist. We identified 339 malpractice claims made against general surgeons. There were 159 (56.3%) accepted claims, and the median compensation paid was 164,381 USD. In multivariable analyses, system (odds ratio, 27.2 95% confidence interval 13.8–53.5) and diagnostic errors (odds ratio 5.3, 95% confidence interval 2.7–10.5) had a significant statistical association with accepted claims. The SURPASS checklist may have prevented 7% and 10% of the accepted claims and systemic errors, respectively. It is unclear what proportion of accepted claims indicated that general surgeon loses should be prevented from performing surgery if the SURPASS checklist were used. In conclusion, systemic and diagnostic errors were associated with accepted claims. Surgical teams should adhere to the SURPASS checklist to enhance patient safety and reduce surgeon risk.

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Abbreviations

CI:

Confidence interval

IQR:

Interquartile range

OR:

Odds ratio

SURPASS:

Surgical Patient Safety System

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Funding

This work was supported by the national academic research grant funds (JSPS KAKENHI: 17K15745, 20H03913). The sponsor of the study had no role in the study design, data collection, analysis, or preparation of the manuscript.

Author information

Authors and Affiliations

  1. Department of Surgery, Tochigi Medical Center Shimotsuga, Tochigi, Japan

    Jun Watanabe

  2. Scientific Research WorkS Peer Support Group (SRWS-PSG), Osaka, Japan

    Jun Watanabe, Norio Yamamoto & Shiho Oide

  3. Department of Orthopedic Surgery, Miyamoto Orthopedic Hospital, Okayama, Japan

    Norio Yamamoto

  4. Department of Obstetrics and Gynecology, Yodogawa Christian Hospital, Osaka, Japan

    Ayako Shibata

  5. Urogynecology Center, Kameda Medical Center, Chiba, Japan

    Shiho Oide

  6. General Medicine Center, Shimane University Hospital, Izumo, Shimane, Japan

    Takashi Watari

  7. Division of Hospital Medicine, University of Michigan Medical School, Ann Arbor, MI, USA

    Takashi Watari

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  1. Jun Watanabe
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  2. Norio Yamamoto
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  3. Ayako Shibata
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Correspondence to Takashi Watari.

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Watanabe, J., Yamamoto, N., Shibata, A. et al. The impact and prevention of systemic and diagnostic errors in surgical malpractice claims in Japan: a retrospective cohort study. Surg Today 53, 562–568 (2023). https://doi.org/10.1007/s00595-022-02590-9

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  • DOI: https://doi.org/10.1007/s00595-022-02590-9

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