Trauma surgery malpractice risk: perception versus reality.
OBJECTIVE
We set out to compare the malpractice lawsuit risk and incidence in trauma surgery, emergency surgery, and elective surgery at a single academic medical center.


BACKGROUND
The perceived increased malpractice risk attributed to trauma patients discourages participation in trauma call panels and may influence career choice of surgeons. When questioned, surgeons cite malpractice risk as a rationale for not providing trauma care. Little data substantiate or refute the perceived high trauma malpractice risk. We hypothesized that the malpractice risk was equivalent between an elective surgical practice and a trauma/emergency practice.


METHODS
Three prospectively maintained institutional databases were used to calculate and characterize malpractice incidence and risk: a surgical operation database, a trauma registry, and a risk management/malpractice database. Risk groups were divided into elective general surgery (ELECTIVE), urgent/emergent, nontrauma general surgery (URGENT), and trauma surgery (TRAUMA). Malpractice claims incidence was calculated by dividing the total number of filed lawsuits by the total number of operative procedures over a 12-year period.


RESULTS
Over the study period, 62,350 operations were performed. A total of 21 lawsuits were served. Seven were dismissed. Three were granted summary judgments to the defendants. Ten were settled with payments to the plaintiffs. One went to trial and resulted in a jury verdict in favor of the defendants. Total paid liability was 4.7 million dollars(391,667 dollars/year). Total legal defense costs were 1.3 million dollars(108,333 dollars/year). The ratio of lawsuits filed/operations performed and incidence in the 3 groups is as follows: ELECTIVE 14/39,080 (3.0 lawsuits/100,000 procedures/year), URGENT 5/17,958, (2.3 lawsuits/100,000 procedures/year), and TRAUMA 2/5312 (3.1/100,000 procedures/year). During the study period, there were an estimated 49,435 trauma patients evaluated. The incidence of malpractice lawsuits using this denominator is 0.34 lawsuits/100,000 patients/year.


CONCLUSIONS
These data demonstrate no increased risk of lawsuit when caring for trauma patients, and the actual risk of a malpractice lawsuit was low.
Stewart
Ronald M
RM
Department of Surgery, University of Texas Health Science Center at San Antonio University Hospital, San Antonio Texas 78229, USA. stewartr@uthscsa.edu
Johnston
Joe
J
Geoghegan
Kathy
K
Anthony
Tiffany
T
Myers
John G
JG
Dent
Daniel L
DL
Corneille
Michael G
MG
Danielson
Daren S
DS
Root
H David
HD
Pruitt
Basil A
BA
Cohn
Stephen M
SM
D016208:Databases, Factual; D013502:General Surgery / Q000191:economics / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data; D006801:Humans; D016365:Liability, Legal / Q000191:economics; D008318:Malpractice / Q000706:statistics & numerical data*; D018570:Risk Assessment; D013781:Texas; D014194:Traumatology / Q000191:economics / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data