Elsevier

Surgery for Obesity and Related Diseases

Volume 3, Issue 1, January–February 2007, Pages 60-66
Surgery for Obesity and Related Diseases

Original article
Medicolegal analysis of 100 malpractice claims against bariatric surgeons

Presented at the Annual Meeting of the American Society of Bariatric Surgery, July 1, 2006, San Francisco, California
https://doi.org/10.1016/j.soard.2006.10.008Get rights and content

Abstract

Background

Very few studies have addressed malpractice litigation specific to bariatric surgery. This study was designed to analyze litigation trends in bariatric surgery to prevent further lawsuits and improve patient care.

Methods

A total of 100 consecutive bariatric lawsuits were reviewed by a consortium of experienced bariatric surgeons and an attorney specializing in medical malpractice.

Results

Of the 100 lawsuits, 45% were reviewed for defense attorneys. The mean patient age was 40 years (range 18–65), 75% were women, 81% had a body mass index of <60, 31% were diabetic, and 38% had sleep apnea. Of the surgeons, 42% had <1 year of experience, and 26% had done <100 cases. Although 69% of the physicians were members of the American Society of Bariatric Surgery, only 22% had detailed consent forms. The surgical procedures were performed between 1997 and 2005 and included Roux-en-Y gastric bypass (78% total, 33% open, and 45% laparoscopic), vertical banded gastroplasty (3%), minigastric bypass (6%), biliopancreatic diversion/duodenal switch (4%), and revision (9%). Of the 100 cases, 32% involved an intraoperative complication and 72% required additional surgery. The most common adverse events initiating litigation were leaks (53%), intra-abdominal abscess (33%), bowel obstruction (18%), major airway events (10%), organ injury (10%), and pulmonary embolism (8%). From these injuries, 53 patients died, 28% had a full recovery, 12% had a minor disability, and 7% had major disabilities. Evidence of potential negligence was found in 28% of cases. Of these cases, 82% resulted from a delay in diagnosis and 64% from misinterpreted vital signs.

Conclusions

This study found that leaks and delayed diagnosis were the most common cause of litigation. Even experienced bariatric surgeons should understand the most common errors made by others to prevent complications and avoid litigation.

Section snippets

Methods

The members of a consortium of experienced bariatric surgeons reviewed 100 consecutive legal cases that were referred by plaintiff or defense council for expert opinion regarding negligence on behalf of the treating physicians or the treating hospital. Each expert possessed >5 years of experience in bariatric surgery and/or had had completed >1000 bariatric operations. Case data related to patient (plaintiff) demographics, surgeon characteristics (training, experience), the alleged

General

All cases reviewed occurred in 25 states, including Pennsylvania, West Virginia, Utah, Michigan, Georgia, Texas, Rhode Island, Nebraska, Missouri, Virginia, North and South Carolina, Florida, Maryland, Montana, Iowa, Illinois, Washington DC, New York, New Jersey, Ohio, Colorado, California, Oregon, and Washington, from June 1997 to February 2005. The mean interval time between the incident and the expert review was 25 months. Of the 100 cases, 55% were referred by plaintiff attorneys and 45% by

Discussion

Medical malpractice litigation pertaining to bariatric surgery is not new and has been around since the first bariatric procedures were performed in the 1950s. Recently, however, the bariatric surgery community has experienced an increased interest in the subject of bariatric medical malpractice. Coincident with the recent rise in bariatric surgery to >100,000 cases/yr in the United States, much speculation has been present in the legal and lay press regarding increased rates of bariatric

Conclusion

The most common complications of bariatric surgery leading to lawsuits in this study included leak, abscess, obstruction, pulmonary/airway complications, organ injury, and pulmonary emboli. Most of the lawsuits (72%) in this study contained no evidence of negligence on the part of the treating surgeon. The prevention of leaks and their timely diagnosis and treatment is the single most important strategy to improve patient outcomes and prevent malpractice lawsuits related to bariatric surgery.

Disclosures

The authors have no commercial associations that might be a conflict of interest in relation to this article.

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