title: Risk factors for litigation following major transectional bile duct injury sustained at laparoscopic cholecystectomy.
abstract: BACKGROUND
  Bile duct injuries after laparoscopic cholecystectomy often cause long-term morbidity, with a number of patients resorting to litigation. The present study aimed to analyze risk factors for litigation and to quantify the subsequent medicolegal burden.
  
  
  METHODS
  A total of 67/106 patients (26 male) with major laparoscopic cholecystectomy bile duct injuries (LCBDI) and a minimum 2-year follow-up, replied to a questionnaire covering patient perception toward the complication, physical/psychological recovery, and subsequent litigation. These data were collated with prospectively collected data related to the LCBDI and subsequent management, and a multivariate regression model was designed to identify potential risk factors associated with litigation.
  
  
  RESULTS
  Most patients felt they had been inadequately informed prior to surgery [47/67 (70%)] and after the LCBDI [50/67 (75%)], and a majority remained psychologically traumatized at the time of evaluation [50/67 (75%)]. Of these, 22 patients had started litigation by means of a "letter of demand" (LOD; n = 10) or prosecution (n = 12). Nineteen (19/22%) cases have been closed in favor of the plaintiff. There was no difference between the awards for LOD versus prosecution cases, and average compensation was £40,800 versus £89,875, respectively (p = n.s). On multivariate analysis, age < 52 years (p = 0.03), associated vascular injury (p = 0.014), immediate nonspecialist repair (p = 0.009), and perceived incomplete recovery following LCBDI (p = 0.017) were identified as independent predictors for possible litigation.
  
  
  CONCLUSIONS
  On the basis of the present study, nearly one third of patients with major transectional LCBDI are likely to resort to litigation. Younger patients and those in whom repair is attempted prior to specialist referral are likely to initiate litigation.
authors.affiliation: The Liver Unit, Queen Elizabeth Hospital, Edgbaston, Birmingham, B15 2TH, UK.
authors.forename: M T P R
authors.initials: MT
authors.lastname: Perera
authors.forename: M A
authors.initials: MA
authors.lastname: Silva
authors.forename: A J
authors.initials: AJ
authors.lastname: Shah
authors.forename: R
authors.initials: R
authors.lastname: Hardstaff
authors.forename: S R
authors.initials: SR
authors.lastname: Bramhall
authors.forename: J
authors.initials: J
authors.lastname: Issac
authors.forename: J A C
authors.initials: JA
authors.lastname: Buckels
authors.forename: D F
authors.initials: DF
authors.lastname: Mirza
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001649:Bile Duct Diseases / Q000209:etiology; D001652:Bile Ducts / Q000293:injuries*; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects* / Q000331:legislation & jurisprudence*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology; D007603:Jurisprudence; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012307:Risk Factors; D011795:Surveys and Questionnaires; D055815:Young Adult