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Medical Malpractice in Bariatric Surgery: a Review of 140 Medicolegal Claims

  • 2016 SSAT Plenary Presentation
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

Abstract

Objective

Given the current rate of obesity in the USA, it has been estimated that close to half of the US adult population could be obese by 2030, resulting in greater demand for bariatric procedures. Our objective was to analyze malpractice litigation related to bariatric surgery.

Methods

We conducted a retrospective review of Westlaw (Thompson Reuters) of all bariatric operations that resulted in the filing of a malpractice claim. Each case was reviewed for pertinent medicolegal information related to the procedure, claim, and trial.

Results

The search criteria yielded 298 case briefs, of which 140 met inclusion criteria. Thirty-two percent (n = 49) of cases involved male plaintiffs (patients). Mean patient age with standard deviation (SD) was 43 (10) years. The most common procedure litigated was the Roux-en-Y gastric bypass (76 %, n = 107). Overall, the most common alleged reason for a malpractice claim was delay in diagnosis or management of a complication in the postoperative period (n = 66, 47 %), the most common of which was an anastomotic leak (45 %, n = 34). Death was reported in 74 (52 %) cases. Fifty-seven cases (47 %) were decided in favor of the plaintiff (patient), with a median award payout of $1,090,000 (interquartile range [IQR] $412,500 to $2,550,000).

Conclusion

Delay in diagnosing or managing complications in the postoperative setting, most commonly an anastomotic leak, accounted for the majority of malpractice claims. Measures taken to identify and address anastomotic leaks and other complications early in the postoperative period could potentially reduce the amount of filed malpractice claims related to bariatric surgery.

Level of Evidence: III

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References

  1. Ogden CL, Carroll MD, Fryar CD, Flegal KM. Prevalence of Obesity Among Adults and Youth: United States, 2011–2014. NCHS Data Brief. 2015(219):1–8.

  2. Finkelstein EA, Trogdon JG, Cohen JW, Dietz W. Annual medical spending attributable to obesity: payer-and service-specific estimates. Health Aff (Millwood). 2009;28(5):w822-831.

    Article  Google Scholar 

  3. Christou NV, Sampalis JS, Liberman M, et al. Surgery decreases long-term mortality, morbidity, and health care use in morbidly obese patients. Ann Surg. 2004;240(3):416–423; discussion 423–414.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Ponce J, Nguyen NT, Hutter M, Sudan R, Morton JM. American Society for Metabolic and Bariatric Surgery estimation of bariatric surgery procedures in the United States, 2011–2014. Surg Obes Relat Dis. 2015;11(6):1199–1200.

    Article  PubMed  Google Scholar 

  5. Belle SH, Berk PD, Courcoulas AP, et al. Safety and efficacy of bariatric surgery: longitudinal assessment of bariatric surgery. Surg Obes Relat Dis. 2007;3(2):116–126.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Smith MD, Patterson E, Wahed AS, et al. Thirty-day mortality after bariatric surgery: independently adjudicated causes of death in the longitudinal assessment of bariatric surgery. Obes Surg. 2011;21(11):1687–1692.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Morino M, Toppino M, Forestieri P, Angrisani L, Allaix ME, Scopinaro N. Mortality after bariatric surgery: analysis of 13,871 morbidly obese patients from a national registry. Ann Surg. 2007;246(6):1002–1007; discussion 1007–1009.

    Article  PubMed  Google Scholar 

  8. Hutter MM, Schirmer BD, Jones DB, et al. First report from the American College of Surgeons Bariatric Surgery Center Network: laparoscopic sleeve gastrectomy has morbidity and effectiveness positioned between the band and the bypass. Ann Surg. 2011;254(3):410–420; discussion 420–412.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Flum DR, Belle SH, King WC, et al. Perioperative safety in the longitudinal assessment of bariatric surgery. N Engl J Med. 2009;361(5):445–454.

    Article  PubMed  Google Scholar 

  10. Cottam D, Lord J, Dallal RM, et al. Medicolegal analysis of 100 malpractice claims against bariatric surgeons. Surg Obes Relat Dis. 2007;3(1):60–66; discussion 66–67.

    Article  PubMed  Google Scholar 

  11. Podnos YD, Jimenez JC, Wilson SE, Stevens CM, Nguyen NT. Complications after laparoscopic gastric bypass: a review of 3464 cases. Arch Surg. 2003;138(9):957–961.

    Article  PubMed  Google Scholar 

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

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Choudhry AJ, Haddad NN, Rivera M, et al. Medical malpractice in the management of small bowel obstruction: a 33-year review of case law. Surgery. 2016.

  14. Choudhry AJ, Anandalwar SP, Svider PF, Oliver JO, Eloy JA, Chokshi RJ. Uncovering malpractice in appendectomies: a review of 234 cases. J Gastrointest Surg. 2013;17(10):1796–1803.

    Article  PubMed  Google Scholar 

  15. Svider PF, Eloy JA, Folbe AJ, Carron MA, Zuliani GF, Shkoukani MA. Craniofacial surgery and adverse outcomes: an inquiry into medical negligence. Ann Otol Rhinol Laryngol. 2015;124(7):515–522.

    Article  PubMed  Google Scholar 

  16. Svider PF, Vidal GP, Zumba O, et al. Adverse events in carotid endarterectomy from a medicolegal perspective. Vasc Endovascular Surg. 2014;48(5–6):425–429.

    Article  PubMed  Google Scholar 

  17. Colaco M, Sandberg J, Badlani G. Influencing factors leading to malpractice litigation in radical prostatectomy. J Urol. 2014;191(6):1770–1775.

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  19. Cohen TH, Hughes, K. A..Medical Malpractice Insurance Claims in Seven States, 2000–2004. 2007. http://www.bjs.gov/content/pub/pdf/mmicss04.pdf.

  20. Consumer Price Index. 2016; http://www.bls.gov/cpi/.

  21. Fullum TM, Aluka KJ, Turner PL. Decreasing anastomotic and staple line leaks after laparoscopic Roux-en-Y gastric bypass. Surg Endosc. 2009;23(6):1403–1408.

    Article  PubMed  Google Scholar 

  22. Fernandez AZ, Jr., DeMaria EJ, Tichansky DS, et al. Experience with over 3,000 open and laparoscopic bariatric procedures: multivariate analysis of factors related to leak and resultant mortality. Surg Endosc. 2004;18(2):193–197.

    Article  PubMed  Google Scholar 

  23. Carrasquilla C, English WJ, Esposito P, Gianos J. Total stapled, total intra-abdominal (TSTI) laparoscopic Roux-en-Y gastric bypass: one leak in 1000 cases. Obes Surg. 2004;14(5):613–617.

    Article  PubMed  Google Scholar 

  24. Jacobsen HJ, Nergard BJ, Leifsson BG, et al. Management of suspected anastomotic leak after bariatric laparoscopic Roux-en-y gastric bypass. Br J Surg. 2014;101(4):417–423.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Aurora AR, Khaitan L, Saber AA. Sleeve gastrectomy and the risk of leak: a systematic analysis of 4,888 patients. Surg Endosc. 2012;26(6):1509–1515.

    Article  PubMed  Google Scholar 

  26. Gastrointestinal surgery for severe obesity: National Institutes of Health Consensus Development Conference Statement. Am J Clin Nutr. 1992;55(2 Suppl):615S-619S.

  27. Boothman RC, Imhoff SJ, Campbell DA, Jr. Nurturing a culture of patient safety and achieving lower malpractice risk through disclosure: lessons learned and future directions. Front Health Serv Manage. 2012;28(3):13–28.

    PubMed  Google Scholar 

  28. Mahmoud M, Maasher A, Al Hadad M, Salim E, Nimeri AA. Laparoscopic Roux En Y esophago-jejunostomy for chronic leak/fistula after laparoscopic sleeve gastrectomy. Obes Surg. 2016;26(3):679–682.

    Article  PubMed  Google Scholar 

  29. Guetta O, Ovnat A, Shaked G, Czeiger D, Sebbag G. Analysis of morbidity data of 308 cases of laparoscopic sleeve gastrectomy—the Soroka experience. Obes Surg. 2015;25(11):2100–2105.

    Article  PubMed  Google Scholar 

  30. Zellmer JD, Mathiason MA, Kallies KJ, Kothari SN. Is laparoscopic sleeve gastrectomy a lower risk bariatric procedure compared with laparoscopic Roux-en-Y gastric bypass? A meta-analysis. Am J Surg. 2014;208(6):903–910; discussion 909–910.

  31. Tuchtan L, Kassir R, Sastre B, Gouillat C, Piercecchi-Marti MD, Bartoli C. Medico-legal analysis of legal complaints in bariatric surgery: a 15-year retrospective study. Surg Obes Relat Dis. 2015.

  32. Levinson W, Hudak P, Tricco AC. A systematic review of surgeon-patient communication: strengths and opportunities for improvement. Patient Educ Couns. 2013;93(1):3–17.

    Article  PubMed  Google Scholar 

  33. Adamson TE, Baldwin DC, Jr., Sheehan TJ, Oppenberg AA. Characteristics of surgeons with high and low malpractice claims rates. West J Med. 1997;166(1):37–44.

    CAS  PubMed  PubMed Central  Google Scholar 

  34. Levinson W. Physician-patient communication. A key to malpractice prevention. JAMA. 1994;272(20):1619–1620.

    Article  CAS  PubMed  Google Scholar 

  35. Svider PF, Husain Q, Kovalerchik O, et al. Determining legal responsibility in otolaryngology: a review of 44 trials since 2008. Am J Otolaryngol. 2013;34(6):699–705.

    Article  PubMed  Google Scholar 

  36. 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;123(5):1156–1162.

    Article  PubMed  Google Scholar 

  37. Law A. Award (And Settlement) Limits in a Medical Malpractice Case. 2016; http://www.alllaw.com/articles/nolo/medical-malpractice/award-settlement-limits.html.

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Acknowledgment

This publication was made possible by CTSA Grant Number UL1 TR000135 and KL2 TR000136 from the National Center for Advancing Translational Sciences (NCATS), a component of the National Institutes of Health (NIH). Its contents are solely the responsibility of the authors and do not necessarily represent the official view of NIH. The authors would like to thank Naadia M. Chowdhury, BS, from the New York University School of Law for assistance with data collection.

Author Contributions

Dr. Choudhry and Dr. Zielinski had full access to the data and take responsibility for the integrity of the data and the accuracy of the data analysis.

Literature search, study conception, and design: Choudhry, Martin, Zielinski.

Acquisition, analysis, or interpretation of data: Choudhry, Haddad, Zielinski.

Drafting of the manuscript: Choudhry, Martin, Zielinski.

Critical revision of the manuscript: Choudhry, Haddad, Martin, Thiels, Habermann, Zielinski.

Statistical analysis: Choudhry, Haddad, Zielinski.

Administrative, technical, or material support: Choudhry, Martin, Thiels, Zielinski.

Study supervision: Choudhry, Martin, Habermann, Zielinski.

Author information

Authors and Affiliations

  1. Department of Surgery, Mayo Clinic, Rochester, MN, USA

    Asad J. Choudhry, Nadeem N. Haddad, Cornelius A. Thiels & Martin D. Zielinski

  2. Department of Surgery, Madigan Army Medical Center, Tacoma, WA, USA

    Matthew Martin

  3. Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Surgical Outcomes Program, Mayo Clinic, Rochester, MN, USA

    Elizabeth B. Habermann

  4. Division of Trauma, Critical Care, and General Surgery, St. Mary’s Hospital, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

    Martin D. Zielinski

Authors
  1. Asad J. Choudhry
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  2. Nadeem N. Haddad
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Corresponding author

Correspondence to Martin D. Zielinski.

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Choudhry, A.J., Haddad, N.N., Martin, M. et al. Medical Malpractice in Bariatric Surgery: a Review of 140 Medicolegal Claims. J Gastrointest Surg 21, 146–154 (2017). https://doi.org/10.1007/s11605-016-3273-1

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  • DOI: https://doi.org/10.1007/s11605-016-3273-1

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