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Uncovering Malpractice in Appendectomies: a Review of 234 Cases

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Background

General surgery is a “high-risk specialty” with respect to medical malpractice rates, and appendicitis is one of the most common diagnoses encountered by practitioners. Our objectives were to detail issues affecting malpractice litigation regarding appendicitis and appendectomies, including outcomes, awards, alleged causes of malpractice, and other factors instrumental in determining legal responsibility and increasing patient safety.

Study Design

Publically available federal and state court records were examined for pertinent jury verdict and settlement reports. Information from 234 pertinent cases was collected, including alleged causes of malpractice and outcomes.

Results

Of the 234 cases included in this study, the most common factor noted was an alleged delay in diagnosis (67.1 %), followed by intraoperative negligence (16.2 %). Alleged deficits in informed consent, although only specifically cited as a cause of malpractice in 1.3 % of cases, were found to be an important aspect of many cases. In total, 59.8 % of cases were ruled in favor of the physician, 23.7 % in favor of the plaintiff, and 5.5 % reached a settlement. The average plaintiff award was US$794,152, and the average settlement award was US$1,434,286.

Conclusion

An important strategy to decrease liability in a physician's practice is prompt evaluation of an appendicitis patient. An integral part of this is efficient communication between physicians practicing a wide variety of specialties, especially including practitioners in emergency medicine and general surgery. Additionally, completing a thorough informed consent explaining all aspects of the procedure including the factors we outline will not only increase patient awareness of potential risks but also protect the physician in the face of litigation.

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References

  1. Selbst SM, Friedman MJ, Singh SB. Epidemiology and etiology of malpractice lawsuits involving children in US emergency departments and urgent care centers. Pediatr Emerg Care. Mar 2005;21(3):165–169.

    PubMed  Google Scholar 

  2. Hope PA. Reforming the medical professional liability insurance system. Am J Med. May 2003;114(7):622–624.

    Article  PubMed  Google Scholar 

  3. Council. NR. To err is human: building a safer health system. Washington D.C.: National Research Council; 2000 2000.

    Google Scholar 

  4. Thomas EJ, Studdert DM, Newhouse JP, et al. Costs of medical injuries in Utah and Colorado. Inquiry. Fall 1999;36(3):255–264.

    Google Scholar 

  5. Studdert DM, Mello MM, Gawande AA, et al. Claims, errors, and compensation payments in medical malpractice litigation. N Engl J Med. May 11 2006;354(19):2024–2033.

    Article  PubMed  CAS  Google Scholar 

  6. Jena AB, Seabury S, Lakdawalla D, Chandra A. Malpractice risk according to physician specialty. N Engl J Med. Aug 18 2011;365(7):629–636.

    Article  PubMed  CAS  Google Scholar 

  7. Addiss DG, Shaffer N, Fowler BS, Tauxe RV. The epidemiology of appendicitis and appendectomy in the United States. American journal of epidemiology. Nov 1990;132(5):910–925.

    PubMed  CAS  Google Scholar 

  8. Anderson JE, Bickler SW, Chang DC, Talamini MA. Examining a common disease with unknown etiology: trends in epidemiology and surgical management of appendicitis in California, 1995–2009. World journal of surgery. Dec 2012;36(12):2787–2794.

    Article  PubMed  Google Scholar 

  9. Reilly BK, Horn GM, Sewell RK. Hearing loss resulting in malpractice litigation: what physicians need to know. The Laryngoscope. Jan 2013;123(1):112–117.

    Article  PubMed  Google Scholar 

  10. Svider PF, Keeley BR, Zumba O, Mauro AC, Setzen M, Eloy JA. From the operating room to the courtroom: a comprehensive characterization of litigation related to facial plastic surgery procedures. Laryngoscope. 2013 Jan 8; Epub ahead of print; DOI: 10.1002/lary.23905

  11. Wegman B, Stannard JP, Bal BS. Medical liability of the physician in training. Clinical orthopedics and related research. May 2012;470(5):1379–1385.

    Article  Google Scholar 

  12. Svider PF, Sunaryo PL, Keeley BR, Kovalerchik O, Mauro AC, Eloy JA. Characterizing liability for cranial nerve injuries: a detailed analysis of 209 malpractice trials. Laryngoscope. 2013 Jan 29; Epub ahead of print; DOI: 10.1002/lary.23995

  13. Svider PF, Husain Q, Kovalerchik O, et al. Determining legal responsibility in otolaryngology: a review of 44 trials since 2008. Am J Otolaryngol. 2013 Jan 15; Epub ahead of print; DOI: 10.1016/j.amjoto.2012.12.005

  14. Lydiatt DD. Medical malpractice and facial nerve paralysis. Arch Otolaryngol Head Neck Surg. Jan 2003;129(1):50–53.

    Article  PubMed  Google Scholar 

  15. Reilly BK, Horn GM, Sewell RK. Hearing loss resulting in malpractice litigation: What physicians need to know. Laryngoscope. Sep 18 2012.

  16. Nash JJ, Nash AG, Leach ME, Poetker DM. Medical malpractice and corticosteroid use. Otolaryngol Head Neck Surg. Jan 2011;144(1):10–15.

    Article  PubMed  Google Scholar 

  17. Eloy JA, Svider PF, Patel D, Setzen M, Baredes S. Comparison of plaintiff and defendant expert witness qualification in malpractice litigation in otolaryngology. Otolaryngol Head Neck Surg. 2013 Mar 12; Epub ahead of print; DOI: 10.1177/0194599813481943

  18. Kovalerchik O, Mady LJ, Svider PF, et al. Physician accountability in iatrogenic cerebrospinal fluid leak litigation. Int Forum Allergy Rhinol. 2013 Mar 27; Epub ahead of print; DOI: 10.1002/alr.21169

  19. Svider PF, Kovalerchik O, Mauro AC, Baredes S, Eloy JA. Legal liability in iatrogenic orbital injury. Laryngoscope. 2013 Feb 12; Epub ahead of print; DOI: 10.1002/lary.24000

  20. Svider PF, Pashkova AA, Husain Q, et al. Determination of legal responsibility in iatrogenic tracheal and laryngeal stenosis. Laryngoscope. 2013 Feb 12; Epub ahead of print; DOI: 10.1002/lary.23997

  21. Hong SS, Yheulon CG, Sniezek JC. Salivary gland surgery and medical malpractice. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery. Apr 2013;148(4):589–594.

  22. Lekovic GP, Harrington TR. Litigation of missed cervical spine injuries in patients presenting with blunt traumatic injury. Neurosurgery. Mar 2007;60(3):516–522; discussion 522–513.

    Google Scholar 

  23. Frank-Stromborg M, Ganschow JR. Legal issues in the early detection and monitoring of cancer. Seminars in oncology nursing. May 2002;18(2):128–134.

    Article  PubMed  Google Scholar 

  24. Morris LG, Ziff DJ, DeLacure MD. Malpractice litigation after surgical injury of the spinal accessory nerve: an evidence-based analysis. Archives of otolaryngology--head & neck surgery. Jan 2008;134(1):102–107

  25. Mitnick JS, Vazquez MF, Kronovet SZ, Roses DF. Malpractice litigation involving patients with carcinoma of the breast. Journal of the American College of Surgeons. Oct 1995;181(4):315–321.

    PubMed  CAS  Google Scholar 

  26. Blaivas M, Pawl R. Analysis of lawsuits filed against emergency physicians for point-of-care emergency ultrasound examination performance and interpretation over a 20-year period. The American journal of emergency medicine. Feb 2012;30(2):338–341.

    Article  PubMed  Google Scholar 

  27. Studdert DM, Mello MM, Brennan TA. Medical malpractice. N Engl J Med. Jan 15 2004;350(3):283–292.

    Article  PubMed  CAS  Google Scholar 

  28. Leape LL, Brennan TA, Laird N, et al. The nature of adverse events in hospitalized patients. Results of the Harvard Medical Practice Study II. N Engl J Med. Feb 7 1991;324(6):377–384.

    Article  PubMed  CAS  Google Scholar 

  29. Eko FN, Ryb GE, Drager L, Goldwater E, Wu JJ, Counihan TC. Ideal timing of surgery for acute uncomplicated appendicitis. North American journal of medical sciences. Jan 2013;5(1):22–27.

    Article  PubMed  Google Scholar 

  30. Farahnak M, Talaei-Khoei M, Gorouhi F, Jalali A, Gorouhi F. The Alvarado score and antibiotics therapy as a corporate protocol versus conventional clinical management: randomized controlled pilot study of approach to acute appendicitis. The American journal of emergency medicine. Sep 2007;25(7):850–852.

    Article  PubMed  Google Scholar 

  31. Malik AA, Bari SU. Conservative management of acute appendicitis. Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract. May 2009;13(5):966–970.

  32. Styrud J, Eriksson S, Nilsson I, et al. Appendectomy versus antibiotic treatment in acute appendicitis. a prospective multicenter randomized controlled trial. World journal of surgery. Jun 2006;30(6):1033–1037.

    Article  PubMed  Google Scholar 

  33. Hansson J, Korner U, Khorram-Manesh A, Solberg A, Lundholm K. Randomized clinical trial of antibiotic therapy versus appendectomy as primary treatment of acute appendicitis in unselected patients. The British journal of surgery. May 2009;96(5):473–481.

    Article  PubMed  CAS  Google Scholar 

  34. Wray CJ, Kao LS, Millas SG, Tsao K, Ko TC. Acute appendicitis: controversies in diagnosis and management. Current problems in surgery. Feb 2013;50(2):54–86.

    Article  PubMed  Google Scholar 

  35. Flum DR, Morris A, Koepsell T, Dellinger EP. Has misdiagnosis of appendicitis decreased over time? A population-based analysis. JAMA : the journal of the American Medical Association. Oct 10 2001;286(14):1748–1753.

  36. Abou-Nukta F, Bakhos C, Arroyo K, et al. Effects of delaying appendectomy for acute appendicitis for 12 to 24 h. Archives of surgery. May 2006;141(5):504–506; discussion 506–507

  37. Papaziogas B, Tsiaousis P, Koutelidakis I, Giakoustidis A, Atmatzidis S, Atmatzidis K. Effect of time on risk of perforation in acute appendicitis. Acta chirurgica Belgica. Jan-Feb 2009;109(1):75–80.

    Google Scholar 

  38. Greenberger NJ, Blumberg RS, Burakoff R. Current diagnosis & treatment. Gastroenterology, hepatology, & endoscopy. 2nd ed. New York: McGraw-Hill Medical; 2012.

    Google Scholar 

  39. Centers for Disease Control. Number, rate, and standard-error of all-listed surgical and nonsurgical procedures for discharge from short-stay hospitals, by selected procedure categories: United States, 2007.

  40. Andersson RE, Petzold MG. Nonsurgical treatment of appendiceal abscess or phlegmon: a systematic review and meta-analysis. Annals of Surgery. November 2007;246(5):741–748

    Article  PubMed  Google Scholar 

  41. Vidmar N. Medical malpractice and the American jury : confronting the myths about jury incompetence, deep pockets, and outrageous damage awards. Ann Arbor: University of Michigan Press; 1995.

    Google Scholar 

  42. Hirsh HL. Hospital law: the changing scene. Legal medicine annual. 1978:325–359.

  43. Zlotnik Shaul R, Birenbaum S, Evans M. Legal liabilities in research: early lessons from North America. BMC medical ethics. Jun 13 2005;6:E4.

    Article  PubMed  Google Scholar 

  44. Stippler M, Gardner PA, Snyderman CH, Carrau RL, Prevedello DM, Kassam AB. Endoscopic endonasal approach for clival chordomas. Neurosurgery. Feb 2009;64(2):268–277; discussion 277–268.

    Google Scholar 

Download references

Acknowledgments

The authors would like to thank Chris Van Luven, J.D. for his legal input in this manuscript.

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Authors and Affiliations

  1. Department of Surgery, University of Medicine and Dentistry of New Jersey—New Jersey Medical School, Newark, NJ, USA

    Amad J. Choudhry, Seema P. Anandalwar, Asad J. Choudhry, Joseph O. Oliver & Ravi J. Chokshi

  2. Department of Surgery, Division of Surgical Oncology, University of Medicine and Dentistry of New Jersey—New Jersey Medical School, 205 South Orange Avenue, G1228, Newark, NJ, 07103, USA

    Ravi J. Chokshi

  3. Department of Otolaryngology—Head and Neck Surgery, University of Medicine and Dentistry of New Jersey Medical School, Newark, NJ, USA

    Peter F. Svider & Jean Anderson Eloy

  4. Department of Neurological Surgery, University of Medicine and Dentistry of New Jersey—New Jersey Medical School, Newark, NJ, USA

    Jean Anderson Eloy

  5. Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, University of Medicine and Dentistry of New Jersey—New Jersey Medical School, Newark, NJ, USA

    Jean Anderson Eloy

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  1. Amad J. Choudhry
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  2. Seema P. Anandalwar
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Correspondence to Ravi J. Chokshi.

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Choudhry, A.J., Anandalwar, S.P., Choudhry, A.J. et al. Uncovering Malpractice in Appendectomies: a Review of 234 Cases. J Gastrointest Surg 17, 1796–1803 (2013). https://doi.org/10.1007/s11605-013-2248-8

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  • DOI: https://doi.org/10.1007/s11605-013-2248-8

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