title: Analysis of the causes of surgery-related medical disputes in Taiwan: Need for acute care surgeons to improve quality of care.
abstract: BACKGROUND
  This study investigated surgery-related medical disputes and analyzed disease etiologies and the main causes of disputes in order to identify key points for the purpose of improving the quality of surgical patient care in Taiwan.
  
  
  METHODS
  Reports on all surgery-related cases appraised by the Taiwan Witness Examiner Committee of the Department of Health between 2004 and 2008 were reviewed retrospectively by three senior physicians from the emergency department who specialize in both trauma and emergency general surgery. The causes of the various medical disputes were categorized under the following descriptions: operation- or procedure-related complication, anesthesia complication, inappropriate management or decision, delayed diagnosis or misdiagnosis, and unsatisfactory result.
  
  
  RESULTS
  A total of 154 cases were reviewed, of which 39 were trauma-related and 115 were disease-related. The two leading causes of disputes in this review were found to be operation- or procedure-related complications (35.7%) and unsatisfactory results (31.8%), followed by delayed diagnoses or misdiagnoses, inappropriate management, and anesthesia complications. Among these, 74 cases (48.1%) required the care of an acute care surgeon and 40 cases (26.0%) required emergency general surgery intervention.
  
  
  CONCLUSIONS
  Surgery- or procedure-related complications and unsatisfactory treatment results constituted the major causes of medical disputes in Taiwan. The majority of these cases involved acute care surgery; thus, the establishment of an acute care surgery system should be considered to improve patient care. The management of hemorrhagic shock and incarcerated hernia should be reinforced in future medical training.
authors: Division of Trauma, Emergency Department, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Surgery, Cardinal Tien Hospital, New Taipei City, Taiwan, ROC.
authors: Yi-Hsuan
authors: YH
authors: Hu
authors: Division of Trauma, Emergency Department, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Faculty of Medicine, National Yang-Ming University, Cardinal Tien Hospital, New Taipei City, Taiwan, ROC.
authors: Chien-Ying
authors: CY
authors: Wang
authors: Division of Trauma, Emergency Department, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Faculty of Medicine, National Yang-Ming University, Cardinal Tien Hospital, New Taipei City, Taiwan, ROC.
authors: Mu-Shun
authors: MS
authors: Huang
authors: Faculty of Medicine, National Yang-Ming University, Cardinal Tien Hospital, New Taipei City, Taiwan, ROC.
authors: Chen-Hsen
authors: CH
authors: Lee
authors: Division of Trauma, Emergency Department, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Faculty of Medicine, National Yang-Ming University, Cardinal Tien Hospital, New Taipei City, Taiwan, ROC. Electronic address: yswen@vghtpe.gov.tw.
authors: Yi-Szu
authors: YS
authors: Wen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D034462:Dissent and Disputes; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D058996:Quality Improvement; D012189:Retrospective Studies; D066231:Surgeons; D013514:Surgical Procedures, Operative / Q000009:adverse effects*; D055815:Young Adult
keywords: acute care surgery; emergency general surgery; incarcerated hernia; medical dispute; trauma