title: Spine surgery and malpractice liability in the United States.
abstract: BACKGROUND
  The correlation of negative outcomes with aggressiveness of malpractice liability has been questioned in the literature.
  
  
  OBJECTIVE
  The aim of this study was to investigate the association of malpractice liability with unfavorable outcomes and hospitalization charges in spine surgery.
  
  
  METHODS
  This was a retrospective cohort study.
  
  
  METHODS
  The sample included a total of 709,951 patients undergoing spine surgery who were registered in the Nationwide Inpatient Sample (NIS) database from 2005 to 2010.
  
  
  METHODS
  The outcome measures were state-level mortality, length of stay (LOS), and hospitalization charges after spinal surgery.
  
  
  METHODS
  We performed a retrospective cohort study involving patients who underwent spine surgery from 2005 to 2010 and were registered in NIS. We used data from the National Practitioner Data Bank from 2005 to 2010 to create measures of volume and size of malpractice claim payments. Their association of the latter with the outcome measures was investigated.
  
  
  RESULTS
  During the study period, there were 707,951 patients (mean age, 54.4 years, with 49.7% females) who underwent spine surgery and were registered in NIS. In a multivariable regression model, higher number of claims per 100 physicians in a state was associated with increased hospitalization charges (β=0.14; 95% confidence interval [CI], 0.13-0.14) and LOS (β=0.041; 95% CI, 0.036-0.047). On the contrary, there was no association with mortality (odds ratio [OR], 0.99; 95% CI, 0.87-1.12). Larger magnitude of awarded claims was associated with increased hospitalization charges (β=0.08; 95% CI, 0.075-0.09) and LOS (β=0.02; 95% CI, 0.016-0.031). On the contrary, there was no association with mortality (OR, 0.95; 95% CI, 0.82-1.11).
  
  
  CONCLUSIONS
  In the present national study, aggressive malpractice environment was not correlated with mortality but was associated with higher hospitalization charges after spine surgery. Further research is needed to identify ways to regulate the malpractice system to address these disparities.
authors.affiliation: Department of Neurosurgery, Louisiana State University Health Sciences Center, 1541 Kings Hwy, Shreveport, LA 71103, USA.
authors.forename: Symeon
authors.initials: S
authors.lastname: Missios
authors.affiliation: Department of Surgery, Section of Neurosurgery, Dartmouth-Hitchcock Medical Center, One Medical Center Dr., Lebanon, NH 03756, USA. Electronic address: kbekelis@gmail.com.
authors.forename: Kimon
authors.initials: K
authors.lastname: Bekelis
mesh_terms: D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D017722:Hospital Charges; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D007297:Inpatients; D007902:Length of Stay / Q000191:economics; D008297:Male; D008318:Malpractice / Q000191:economics*; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000191:economics*; D019637:Orthopedic Procedures / Q000191:economics*; D017063:Outcome Assessment, Health Care / Q000191:economics; D010820:Physicians / Q000191:economics; D012189:Retrospective Studies; D014481:United States
keywords: Claims; Liability; Malpractice; NIS; NPDB; Spine surgery