Malpractice Litigation Involving Iatrogenic Surgical Vocal Fold Paralysis: A Closed-Claims Review With Recommendations for Prevention and Management
Malpractice Litigation Involving Iatrogenic Surgical Vocal Fold Paralysis: A Closed-Claims Review With Recommendations for Prevention and Management
复制标题
DOI：
10.1177/000348940911800102
复制
发表时间：
2009-01-01
影响因子：
1.4
通讯作者：
Pierce, Elizabeth
中科院分区：
文献类型：
--
作者：
Shaw, Gary Y.;Pierce, Elizabeth
目的：我们描述了涉及外科医源性声带麻痹的医疗事故索赔的性质，回顾外科文献以寻找预防这一并发症的建议，并建议对这一并发症的处理。然后对结果进行分析和分类。回顾了有关这一并发症的PubMed文献，并编写了预防建议。结果：从1986年到2007年，16家最大的医疗事故保险公司共报告了112起声带麻痹索赔。到目前为止，已经支付了1000多万美元(经通胀调整后的1800万美元[Aji])。平均赔款为285,000美元(513,000阿吉)。外科医生被告来自多个专业，包括普通外科(31%)、心胸外科(12%)、神经外科(12%)、耳鼻喉科(10%)。和骨科手术(5%)。最常见的手术是甲状腺和甲状旁腺手术(32%)。颈椎间盘手术(16%)、胸椎手术(12%)、动脉内膜切除术(9%)和开颈活检(6%)。最常见的投诉是操作不当(61%)，未能识别并发症(36%)，以及同意问题(19%)。结论：声带麻痹是跨越多个专科的许多不同外科手术的并发症。封闭索赔分析可以提供一个独特的一瞥哪里出了问题，为什么病人起诉。改进技术和采用新技术可能会显著减少这一并发症。我们认为，术前有关潜在并发症的书面信息，以及喉部专家的早期转介和处理，可能会显著减少医疗事故诉讼。
Objectives: We describe the nature of malpractice claims filed involving surgical iatrogenic vocal fold paralysis, review surgical literature for recommendations for prevention of this complication, and suggest management of this complication.Methods: Data collection was made regarding any closed claims that involved vocal fold paralysis. The results were then analyzed and categorized. The PubMed literature regarding this complication was reviewed, and recommendations on prevention were compiled. Finally, suggestions regarding management based on the current literature and the senior author's 17-year experience in his laryngeal practice are offered.Results: From 1986 to 2007, 112 closed claims involving vocal fold paralysis were reported by the 16 largest malpractice insurers. More than US $10 million ($18 million adjusted for inflation [AJI]) has been paid thus far. The average indemnity was $285,000 ($513,000 AJI). The surgical physician defendants were from multiple specialties, including general surgery (31%), cardiothoracic surgery (12%), neurosurgery (12%), otolaryngology (10%). and orthopedic surgery (5%). The most common procedures were thyroid and parathyroid surgery (32%). cervical disc procedures (16%), thoracic procedures (12%), endarterectomy (9%), and open neck biopsy (6%). The most common claims cited were improper performance (61%), failure to recognize a complication (36%), and consent issues (19%).Conclusions: Vocal fold paralysis is a complication of many different Surgical procedures across multiple specialty lines. Closed-claims analysis can offer a unique glimpse on what went wrong and why patients sue. Modification of techniques and incorporation of new technology may significantly reduce this complication. Preoperative written information on potential complications, and early referral to and management by laryngeal specialists, we believe, may significantly reduce malpractice litigation.