The medicolegal impact of misplaced pedicle and lateral mass screws on spine surgery in the United States

Spine surgery has been disproportionately impacted by medical liability and malpractice litigation, with the majority of claims and payouts related to procedural error. One common area for the potential avoidance of malpractice claims and subsequent payouts involves misplaced pedicle and/or lateral mass instrumentation. However, the medicolegal impact of misplaced screws on spine surgery has not been directly reported in the literature. The authors of the current study aimed to describe this impact in the United States, as well as to suggest a potential method for mitigating the problem.This retrospective analysis of 68 closed medicolegal cases related to misplaced screws in spine surgery showed that neurosurgeons and orthopedic spine surgeons were equally named as the defendant (n = 32 and 31, respectively), and cases were most commonly due to misplaced lumbar pedicle screws (n = 41, 60.3%). Litigation resulted in average payouts of $1,204,422 ± $753,832 between 1995 and 2019, when adjusted for inflation. The median time to case closure was 56.3 (35.2–67.2) months when ruled in favor of the plaintiff (i.e., patient) compared to 61.5 (51.4–77.2) months for defendant (surgeon) verdicts (p = 0.117).

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The Medical Review Panel in Louisiana Neurosurgery and Beyond

Neurosurgery ◽

10.1093/neuros/nyz319 ◽

2019 ◽

Vol 85 (6) ◽

pp. E992-E1001

Author(s):

Jennifer Kosty ◽

Bowen Jiang ◽

Devon C LeFever ◽

Jared R Brougham ◽

Frederick White ◽

...

Keyword(s):

United States ◽

Medical Malpractice ◽

The United States ◽

Medical Liability ◽

Medical Review ◽

Review Panel ◽

The Past ◽

Malpractice Claims ◽

States Data ◽

Medical Malpractice Claims

Abstract For the past several decades, medical malpractice claims in the state of Louisiana have been screened by a pretrial medical review panel (MRP). Composed of 3 physicians and 1 attorney, these panels are a method of filtering nonmeritorious lawsuits while expediting creditable claims. Currently, 14 jurisdictions in the United States require medical liability/malpractice cases be heard by an MRP or screening panel prior to trial. In this article, we review the MRP process in Louisiana and compare it to those in other states. Data are presented for the past 10 yr of malpractice claims in Louisiana with an emphasis on the neurosurgery specialty. Finally, the benefits and challenges of pretrial screening panels are discussed.

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Lawsuits against plastic surgeons: Does locale affect incidence of claims?

Canadian Journal of Plastic Surgery ◽

10.1177/229255030701500309 ◽

2007 ◽

Vol 15 (3) ◽

pp. 155-157 ◽

Cited By ~ 3

Author(s):

Jonathan L Kaplan ◽

Warren C Hammert ◽

James E Zin

Keyword(s):

United States ◽

Emergency Room ◽

Plastic Surgery ◽

Medical Malpractice ◽

The United States ◽

Absolute Number ◽

Malpractice Claims ◽

High Incidence ◽

Medical Malpractice Claims ◽

Geographical Locations

Background Physicians continue to practice in a very litigious environment. Some physicians try to mitigate their exposure to lawsuits by avoiding geographical locations known for their high incidence of medical malpractice claims. Not only are certain areas of the United States known to have a higher incidence of litigation, but it is also assumed that certain areas of the hospital incur a greater liability. There seems to be a medicolegal dogma suggesting a higher percentage of malpractice claims coming from patients seen in the emergency room (ER), as well as higher settlements for ER claims. Objective To determine if there is any validity to the dogma that a higher percentage of malpractice claims arise from the ER. Methods An analysis of common plastic surgery consults that result in malpractice claims was performed. The location where the basis for the lawsuit arose – the ER, office (clinic) or the operating room (OR) – was evaluated. The value of the indemnity paid and whether its value increased or decreased based on the location of the misadventure was evaluated. Results According to the data, which represented 60% of American physicians, there was a larger absolute number of malpractice claims arising from the OR, not the ER. However, the highest average indemnity was paid for cases involving amputations when the misadventure originated in the ER. Conclusions The dogma that a greater percentage of lawsuits come from incidents arising in the ER is not supported. However, depending on the patient's injury and diagnosis, a lawsuit from the ER can be more costly than one from the OR.

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Radiology Malpractice Claims in the United States From 2008 to 2012: Characteristics and Implications

Journal of the American College of Radiology ◽

10.1016/j.jacr.2015.07.013 ◽

2016 ◽

Vol 13 (2) ◽

pp. 124-130 ◽

Cited By ~ 16

Author(s):

H. Benjamin Harvey ◽

Elena Tomov ◽

Astrid Babayan ◽

Kathy Dwyer ◽

Sam Boland ◽

...

Keyword(s):

United States ◽

The United States ◽

Malpractice Claims

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Trends in medical malpractice claims in patients with cleft or craniofacial abnormalities in the United States

International Journal of Pediatric Otorhinolaryngology ◽

10.1016/j.ijporl.2016.09.030 ◽

2016 ◽

Vol 90 ◽

pp. 214-219 ◽

Cited By ~ 4

Author(s):

Rounak B. Rawal ◽

Lauren A. Kilpatrick ◽

Jeyhan S. Wood ◽

Amelia F. Drake

Keyword(s):

United States ◽

Medical Malpractice ◽

The United States ◽

Craniofacial Abnormalities ◽

Malpractice Claims ◽

Medical Malpractice Claims

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Association of Medicaid expansion under the Affordable Care Act with access to elective spine surgical care

Journal of Neurosurgery Spine ◽

10.3171/2021.3.spine2122 ◽

2021 ◽

pp. 1-9

Author(s):

Jacob K. Greenberg ◽

Derek S. Brown ◽

Margaret A. Olsen ◽

Wilson Z. Ray

Keyword(s):

United States ◽

Spine Surgery ◽

Surgical Procedures ◽

Affordable Care Act ◽

Surgical Care ◽

The United States ◽

Medicaid Expansion ◽

Percentage Points ◽

The Affordable Care Act ◽

The Impact

OBJECTIVE The Affordable Care Act expanded Medicaid eligibility in many states, improving access to some forms of elective healthcare in the United States. Whether this effort increased access to elective spine surgical care is unknown. This study’s objective was to evaluate the impact of Medicaid expansion under the Affordable Care Act on the volume and payer mix of elective spine surgery in the United States. METHODS This study evaluated elective spine surgical procedures performed from 2011 to 2016 and included in the all-payer State Inpatient Databases of 10 states that expanded Medicaid access in 2014, as well as 4 states that did not expand Medicaid access. Adult patients aged 18–64 years who underwent elective spine surgery were included. The authors used a quasi-experimental difference-in-difference design to evaluate the impact of Medicaid expansion on hospital procedure volume and payer mix, independent of time-dependent trends. Subgroup analysis was conducted that stratified results according to cervical fusion, thoracolumbar fusion, and noninstrumented surgery. RESULTS The authors identified 218,648 surgical procedures performed in 10 Medicaid expansion states and 118,693 procedures performed in 4 nonexpansion states. Medicaid expansion was associated with a 17% (95% CI 2%–35%, p = 0.03) increase in mean hospital spine surgical volume and a 23% (95% CI −0.3% to 52%, p = 0.054) increase in Medicaid volume. Privately insured surgical volumes did not change significantly (incidence rate ratio 1.13, 95% CI −5% to 34%, p = 0.18). The increase in Medicaid volume led to a shift in payer mix, with the proportion of Medicaid patients increasing by 6.0 percentage points (95% CI 4.1–7.0, p < 0.001) and the proportion of private payers decreasing by 6.7 percentage points (95% CI 4.5–8.8, p < 0.001). Although the magnitude of effects varied, these trends were similar across procedure subgroups. CONCLUSIONS Medicaid expansion under the Affordable Care Act was associated with an economically and statistically significant increase in spine surgery volume and the proportion of surgical patients with Medicaid insurance, indicating improved access to care.

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