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Article Abstract
Objective: To characterize malpractice claims, analyze the litigation outcomes, and educate neurosurgeons on prevention and handling of wrong-side procedures in neurosurgery.
Methods: A retrospective review of closed malpractice claims involving wrong-side cranial and spinal surgery cases was conducted utilizing WestLaw and LexisNexis legal databases and grey literature. Clinical and legal characteristics were collected, including patient demographics, surgical and legal details, and case outcome. All characteristics were compared using independent samples t-tests and chi-square tests.
Results: Of the initial 283 screened cases, 28 met the final inclusion criteria spanning 1986-2023. Of 19 (68%) known outcomes, 16 (84%) resulted in a plaintiff verdict. Most claims involved cranial surgery (n=21, 75%). Among plaintiff outcomes with a documented payout value (n=11, 44%), the median, inflation-adjusted award payout was $603,502 (range: $23,394-$37,298,104). The largest median payouts involved patients under 18-years-old ($11,250,000). Only three defendant outcomes were found, all based on procedural grounds. No significant differences were found between occurrence in the 20 years before and after the institution of the Universal Protocol. Statistical significance was found between the type of cranial pathology and award payout by practice setting (p<.001, p=.025).
Conclusions: This descriptive analysis provides insight into the multifaceted characteristics of malpractice litigation involving wrong-side procedures in cranial and spine surgery. Defendant rulings on merit are exceedingly rare, while settlements typically involve lower monetary values than verdict awards. Effective management strategies include prompt communication with family and hospital administration, early conflict resolution, and settlement consideration, given the potential negative publicity associated with these tragic events.
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