title: Craniofacial Surgery and Adverse Outcomes: An Inquiry Into Medical Negligence.
abstract: OBJECTIVE
  This study aimed to evaluate factors contributing to medical negligence relevant to craniofacial surgery.
  
  
  METHODS
  Retrospective analysis of verdict and settlement reports on the Westlaw legal database for outcome, awards, physician defendants, and other specific factors raised in malpractice litigation.
  
  
  RESULTS
  Of 42 verdicts and settlement reports included, 52.4% were resolved with either an out-of-court settlement or plaintiff verdict, with aggregate payments totaling $50.1M (in 2013 dollars). Median settlements and jury-awarded damages were $988,000 and $555,000, respectively. Payments in pediatric cases ($1.2M) were significantly higher. Plastic surgeons, oral surgeons, and otolaryngologists were the most commonly named defendants. The most common alleged factors included intraoperative negligence (69.0%), permanent deficits (54.8%), requiring additional surgery (52.4%), missed/delayed diagnosis of a complication (42.9%), disfigurement/scarring (28.6%), postoperative negligence (28.6%), and inadequate informed consent (20.6% of surgical cases). Failure to diagnose a fracture (19.0%) and cleft-reparative procedures (14.3%) were the most frequently litigated entities.
  
  
  CONCLUSIONS
  Medical negligence related to craniofacial surgery involves plaintiffs in a wide age range as well as physician defendants in numerous specialties, and proceedings resolved with settlement and plaintiff verdict involve substantial payments. Cases with death, allegedly permanent injuries, and pediatric plaintiffs had significantly higher payments.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan, USA.
authors.forename: Peter F
authors.initials: PF
authors.lastname: Svider
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey, USA jean.anderson.eloy@gmail.com.
authors.forename: Jean Anderson
authors.initials: JA
authors.lastname: Eloy
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan, USA.
authors.forename: Adam J
authors.initials: AJ
authors.lastname: Folbe
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan, USA.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Carron
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan, USA.
authors.forename: Giancarlo F
authors.initials: GF
authors.lastname: Zuliani
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan, USA Division of Facial Plastic and Reconstructive Surgery/Craniofacial Surgery, Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan, USA.
authors.forename: Mahdi A
authors.initials: MA
authors.lastname: Shkoukani
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D019465:Craniofacial Abnormalities / Q000601:surgery*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008318:Malpractice / Q000331:legislation & jurisprudence*; D008875:Middle Aged; D010036:Otolaryngology / Q000331:legislation & jurisprudence*; D013517:Otorhinolaryngologic Surgical Procedures / Q000331:legislation & jurisprudence*; D017063:Outcome Assessment, Health Care / Q000331:legislation & jurisprudence*; D012189:Retrospective Studies; D014481:United States; D055815:Young Adult
keywords: cleft lip; cleft palate; craniofacial; facial fracture; malpractice; negligence