title: Counting the cost of negligence in neurosurgery: Lessons to be learned from 10 years of claims in the NHS.
abstract: BACKGROUND
  Despite substantial progress in modernising neurosurgery, the specialty still tops the list of medico-legal claims. Understanding the factors associated with negligence claims is vital if we are to identify areas of underperformance and subsequently improve patient safety. Here we provide data on trends in neurosurgical negligence claims over a 10-year period in England.
  
  
  METHODS
  We used data provided by the National Health Service Litigation Authority to analyse negligence claims related to neurosurgery from the financial years 2002/2003 to 2011/2012. Using the abstracts provided, we extracted information pertaining to the underlying pathology, injury severity, nature of misadventure and claim value.
  
  
  RESULTS
  Over the 10-year period, the annual number of claims increased significantly. In total, there were 794 negligence claims (range 50-117/year); of the 613 closed cases, 405 (66.1%) were successful. The total cost related to claims during the 10 years was £65.7 million, with a mean claim per successful case of £0.16 million (total damages, defence and claimant costs of £45.1, £6.36 and £14.3 million, respectively). Claims related to emergency cases were more costly compared to those of elective cases (£209,327 vs. £112,627; P=0.002). Spinal cases represented the most frequently litigated procedures (350; 44.1% of total), inadequate surgical performance the most common misadventure (231; 29.1%) and fatality the commonest injury implicated in claims (102; 12.8%). Negligence claims related to wrong-site surgery and cauda equina syndrome were frequently successful (26/26; 100% and 14/16; 87.5% of closed cases, respectively).
  
  
  CONCLUSIONS
  In England, the number of neurosurgical negligence claims is increasing, the financial cost substantial, and the burden significant. Lessons to be learned from the study are of paramount importance to reduce future cases of negligence and improve patient care.
authors.affiliation: Department of Neurosurgery, James Cook University Hospital , Middlesbrough , UK.
authors.forename: Alhafidz
authors.initials: A
authors.lastname: Hamdan
authors.forename: Roger D
authors.initials: RD
authors.lastname: Strachan
authors.forename: Fredrick
authors.initials: F
authors.lastname: Nath
authors.forename: Ian C
authors.initials: IC
authors.lastname: Coulter
mesh_terms: D004739:England; D008318:Malpractice; D019300:Medical Errors / Q000331:legislation & jurisprudence*; D009493:Neurosurgery / Q000191:economics / Q000639:trends*; D019635:Neurosurgical Procedures / Q000639:trends; D005791:Patient Care; D013222:State Medicine
keywords: judicial guidance; litigation issues; national trends; negligence; surgical performance