Lessons learned in otologic surgery: 30 years of malpractice cases in the United States.
OBJECTIVE
To analyze malpractice litigation trends to better understand the causes and outcomes of suits involving otologic surgeries to prevent future litigation and improve physician awareness.


METHODS
Court records of legal trials from 1983 to 2012 were obtained from 2 major computerized databases-WESTLAW and LexisNexis. Data were compiled on the demographics of the defendant, plaintiff, use of otolaryngologists/otologists as expert witnesses, nature of injury, type of surgery, legal allegations, verdicts, and judgments.


RESULTS
Fifty-eight unique cases met inclusion criteria and were selected for review. The most common surgeries that went to trial were mastoidectomy (48%), ossiculoplasty (21%), and tympanoplasty (16%). Eleven (19%) of the cases were resolved through a settlement before a verdict was reached. Verdicts in favor of the plaintiffs (31%) were awarded an average of $1,131,189. The most common alleged injuries were hearing loss (45%) and facial nerve injury (38%). Of the cases found in favor of the plaintiff, the most common reasons cited were improper performance of the surgery (50%), failure to properly diagnose and treat (33%), and inadequate informed consent and delay in diagnosis (22% each). Case outcomes involving pediatric patients were not significantly different than those of adults (p = 0.34); however, adults received higher financial awards on average ($1 million versus $232,000; p < 0.0003).


CONCLUSIONS
Obtaining an appropriate diagnosis, thoroughly discussing all options and potential risks, presenting realistic expectations, and executing the surgery correctly are crucial to patient care. Understanding the reasons surgeons go to trial may assist in mitigating risk for potential lawsuits.
Tripler Army Medical Center, Department of Otolaryngology-Head and Neck Surgery, Honolulu, Hawaii 96859, USA. douglas.ruhl@amedd.army.mil
Douglas S
DS
Ruhl
Steven S
SS
Hong
Philip D
PD
Littlefield
D000328:Adult; D002648:Child; D016208:Databases, Factual; D020220:Facial Nerve Injuries / Q000150:complications / Q000209:etiology; D006099:Granuloma / Q000209:etiology; D034381:Hearing Loss / Q000150:complications / Q000209:etiology; D006801:Humans; D007258:Informed Consent; D008318:Malpractice / Q000331:legislation & jurisprudence*; D013506:Otologic Surgical Procedures / Q000009:adverse effects / Q000331:legislation & jurisprudence*; D011183:Postoperative Complications / Q000175:diagnosis / Q000628:therapy; D013201:Stapes Surgery / Q000009:adverse effects; D016896:Treatment Outcome; D014481:United States