title: Image-guidance in endoscopic sinus surgery: is it associated with decreased medicolegal liability?
abstract: BACKGROUND
  The use of image-guidance (IG) in endoscopic sinus surgery (ESS) has escalated over the last decade despite a lack of consensus that its use improves outcomes or decreases complications. One theoretical reason for using IG in ESS is its potential to minimize legal liability should an adverse outcome occur. In this study, we aimed to characterize the role of IG in ESS litigation, and further detail other factors in pertinent cases. A secondary objective was to characterize recent malpractice litigation for other relevant factors.
  
  
  METHODS
  Relevant cases from Westlaw were examined to determine whether the use of IG played a role in initiating litigation in ESS malpractice suits. Factors such as patient demographics and alleged cause(s) of malpractice litigation were examined.
  
  
  RESULTS
  Out of 30 malpractice cases from 2004 to April 2013, 4 (13.3%) mentioned the use of IG during ESS, although this did not appear to be a factor affecting the plaintiff's decision to initiate litigation, nor the case outcomes. In the 26 cases (86.7%) in which IG was not used, its non-use was not specified as an alleged cause of negligence. Eleven (36.7%) cases were resolved in the defendant's favor. Frequently-cited factors included iatrogenic injury (83.3%), permanent deficits (66.7%), needing additional surgery (63.3%), orbital and intracranial injury, and perceived deficits in informed consent (40.0%).
  
  
  CONCLUSIONS
  The use of IG was not found to be a factor in ESS litigation. This suggests that not using IG does not necessarily make one more vulnerable to malpractice litigation.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ; Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, NJ; Center for Skull Base and Pituitary Surgery, Rutgers New Jersey Medical School, Newark, NJ.
authors.forename: Jean Anderson
authors.initials: JA
authors.lastname: Eloy
authors.forename: Peter F
authors.initials: PF
authors.lastname: Svider
authors.forename: Christine M
authors.initials: CM
authors.lastname: D'Aguillo
authors.forename: Soly
authors.initials: S
authors.lastname: Baredes
authors.forename: Michael
authors.initials: M
authors.lastname: Setzen
authors.forename: Adam J
authors.initials: AJ
authors.lastname: Folbe
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D004724:Endoscopy / Q000009:adverse effects* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D016365:Liability, Legal; D008297:Male; D008318:Malpractice / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data; D008875:Middle Aged; D010256:Paranasal Sinuses / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D012307:Risk Factors; D025321:Surgery, Computer-Assisted / Q000009:adverse effects* / Q000706:statistics & numerical data; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
keywords: endoscopic sinus surgery; image guidance; legal liability; medical malpractice; medicolegal