title: Verdicts on malpractice claims after thyroid surgery: emerging trends and future directions.
abstract: BACKGROUND
  Few investigations have addressed malpractice litigation after thyroid surgery. The purpose of this medico-legal review was to provide a more comprehensive picture of medico-legal trends in thyroid surgery.
  
  
  METHODS
  Reviewed were all expert opinions on claims of malpractice after thyroid surgery, commissioned between 1995 and 2010 at 1 tertiary center, and their corresponding verdicts.
  
  
  RESULTS
  Forty-three of 75 malpractice claims involved recurrent laryngeal nerve (RLN) palsy (21 unilateral and 22 bilateral palsies), with a 45% tracheostomy rate for bilateral RLN palsy. Twenty-one claims concerned permanent hypoparathyroidism. Since 2007, intraoperative nerve monitoring (IONM) has become the subject of pleading in 4 of 7 malpractice claims involving unilateral or bilateral RLN palsy. In none of these cases did IONM follow international standards, resulting in 3 plaintiff verdicts.
  
  
  CONCLUSIONS
  The growing appreciation that standardized IONM can prevent bilateral RLN palsies after signal loss on the initial side of resection may become increasingly relevant to malpractice litigation.
authors.affiliation: Department of General, Visceral and Vascular Surgery, University Hospital and Medical Faculty, University of Halle-Wittenberg, Halle/Saale, Germany. henning.dralle@uk-halle.de
authors.forename: Henning
authors.initials: H
authors.lastname: Dralle
authors.forename: Kerstin
authors.initials: K
authors.lastname: Lorenz
authors.forename: Andreas
authors.initials: A
authors.lastname: Machens
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008318:Malpractice / Q000706:statistics & numerical data*; D019300:Medical Errors / Q000706:statistics & numerical data*; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D013961:Thyroid Gland / Q000601:surgery*; D013965:Thyroidectomy / Q000009:adverse effects* / Q000191:economics; D055815:Young Adult