Objective: General surgery among other surgical subspecialties is deemed a high legal risk specialty with one of the highest malpractice premiums in medicine. Hernia surgery is among one of the most common surgical procedures performed by general surgeons in the USA. However, there remains a relative paucity of data into reasons for litigation. We aimed to understand medical litigation related to hernia surgery.
Methods: Westlaw Next (Thomson Reuters, New York, NY), a comprehensive law dataset with publicly available records from jurisdictions throughout the USA was queried. Using the terms medical malpractice and hernia operations we searched all jury verdicts and settlements. Target operations included inguinal, femoral, ventral, umbilical, parastomal, spigelian, obturator, epigastric, incisional, paraumbilical and pantaloon hernias. We excluded hiatal, diaphragmatic, sciatic, gluteal and lumbar hernias as the primary focus was abdominal wall hernias. Additional exclusion criteria included cases where the hernia surgery was not the primary reason for litigation. Factorial information included: patient demographics, physician specialty, procedural characteristics, alleged reason for the malpractice claim and outcome(s) of trial.
Results: The search criteria yielded 1099 case briefs; 433 cases met inclusion criteria. Dates of cases ranged from 1985 to 2018. Most of the patients involved in cases were male; mean patient age was 50 ± 15. The two most common hernia procedures litigated were inguinal and ventral hernia repairs (>90%). The states of New York and California had the highest number of medical malpractice cases reported. Alleged informed consent breech was claimed in >15% of cases. The most common alleged reason for litigation was intraoperative damage to surrounding structures. Overall 59% of cases were decided in favor of the defendant (physician). Median jury verdict and settlement sums for the plaintiff was $700,000.
Conclusion: Surgical complications played a significant role in outcomes of malpractice litigation in cases. Most of the cases were decided in the favor of the defendant; however, settlements and cases with a jury verdict in favor of the plaintiff were costly. By understanding reasons why surgeons go to trial and enacting changes to mitigate complications leading to litigation along with medicolegal reform; the burden of future litigation may be lessened.