Spine-Related Malpractice Claims in China: A 2-year National Analysis

Study design Retrospective cross-sectional study. Objective To investigate the prevalence, characteristics, and risk factors of spine-related malpractice claims in China in a 2-year period. Methods The arbitration files of the Chinese Medical Association (CMA) were reviewed for spine-related malpractice claims. Descriptive statistics and correlation analysis were conducted on claim characteristics, clinical data, plaintiff’s main allegations, and arbitration outcomes. Results A total of 288 cases of spinal claims filed in the CMA between January 2016 and December 2017 were included. Most claims were found in lumbar degenerative disorders (59.4%), lumbar trauma (13.2%), and cervical degenerative disorders (11.8%). The most common adverse events (AEs) leading to claims were new neurologic deficit (NND) (47.6%), infection (11.5%), and insufficient symptom relief (10.4%). The most common patient allegation was surgical error (66.0%), although the main arbitrated cause of AEs was disease/treatment itself (49.0%), while providers were judged as mainly responsible in only 47.3% cases. In multivariate regression analysis, cervical spine, misdiagnosis/mistreatment, and unpredictable emergency correlated with more severe damage to patients; minimally invasive surgery was predictive of judgment in plaintiff’s favor, while claims in the eastern region and unpredictable emergencies were predictive of defendant’s favor; only NND was associated with being arbitrated as surgical error in surgical cases where surgeons accepted major liability. Conclusion The current study provided a descriptive overview and risk factor analysis of spine-related malpractice claims in China. Gaining improved understanding of the facts and causes of malpractice claims may help providers reduce the risk of claims and subsequent litigation.

Real-time acoustic sensing and artificial intelligence for error prevention in orthopedic surgery

In this work, we developed and validated a computer method capable of robustly detecting drill breakthrough events and show the potential of deep learning-based acoustic sensing for surgical error prevention. Bone drilling is an essential part of orthopedic surgery and has a high risk of injuring vital structures when over-drilling into adjacent soft tissue. We acquired a dataset consisting of structure-borne audio recordings of drill breakthrough sequences with custom piezo contact microphones in an experimental setup using six human cadaveric hip specimens. In the following step, we developed a deep learning-based method for the automated detection of drill breakthrough events in a fast and accurate fashion. We evaluated the proposed network regarding breakthrough detection sensitivity and latency. The best performing variant yields a sensitivity of $$93.64 \pm 2.42$$ 93.64 ± 2.42 % for drill breakthrough detection in a total execution time of 139.29$${\hbox { ms}}$$ ms . The validation and performance evaluation of our solution demonstrates promising results for surgical error prevention by automated acoustic-based drill breakthrough detection in a realistic experiment while being multiple times faster than a surgeon’s reaction time. Furthermore, our proposed method represents an important step for the translation of acoustic-based breakthrough detection towards surgical use.

Surgical error

not available Journal of Surgical Sciences (2018) Vol. 22 (1): 9-10

Adjustable correlated colour temperature for surgical lighting

A surgical luminaire containing two types of phosphor-converted LEDs was employed to illuminate a large midline incision in a 90 kg pig. The PC-LEDs were proportionally blended to create four spectra defined by their approximate correlated colour temperatures: 3000, 4000, 4500 and 5100 K. Sixteen surgeons evaluated the colour appearance of internal anatomy under each spectrum. All four spectra were rated as highly effective. There was no significant difference between the 4000, 4500 and 5100 K spectra. The 3000 K spectrum was rated as less effective, though this does not mean it was ineffective. The spectrum by participant interaction was significant where it could be estimated, suggesting that surgeons may develop individual opinions about which spectra are most effective. While the surgeons moderately agreed that the colour of internal anatomy was altered by the different spectra, they were undecided whether the differences would increase the risk of surgical error or influence surgical decisions. They were also largely undecided whether they would select different spectra during a single procedure, for different procedures, or for different anatomy. Overall, the linear mixing for variable CCT employed in this experiment did not provide obvious utility for surgeons making visual evaluations.