Healthcare Delivery, Quality, and SafetyLitigation Patterns in Inguinal Hernia Surgery: A 25 Year Review
Introduction
Medical malpractice torts are a seemingly inevitable aspect of practicing medicine in the United States. A 2008 analysis estimated the national cost of medical liability to be over $55 billion.1 Across all specialties, claims result in substantial costs to practitioners and their insurance providers, at an average of $20,000-$30,000 per claim and $40,000-$500,000 per claim with an indemnity.2
In comparison with other specialties, general surgeons are at relatively high risk for litigation.3 In addition, the size of payment in surgical malpractice claims is reported to be higher than claims across all specialties, with a median payment of $132,915.4 Surgeons are increasingly faced with malpractice claims, with 15% of surgeons encountering a claim annually and 99% facing a claim by the age of 65 y. In addition, over 60% of surgeons will face an indemnity.3 Consequently, malpractice insurance premiums have risen by as much as 20% per y for general surgeons nationally in recent years.5 Moreover, the financial payouts resulting from insurance claims have grown in size and frequency, prompting increasing calls for reform and recent changes in medical malpractice laws.6
The consequences of frequent litigation are not solely financial. Studies indicate that malpractice defense contributes to physician burnout, depression, and suicidal ideation.7
Medical litigation has been carefully examined for a variety of other procedures within the scope of general surgery.8, 9, 10 However, no thorough analysis has yet been conducted pertaining to patterns in inguinal hernia surgery. The purpose of this study is to better understand the causes and outcomes of lawsuits involving inguinal hernia surgery, to improve patient care and avoid potential litigation. We believe this to be important as inguinal hernia is one of the most commonly encountered general surgery pathologies in the world. Approximately 27% of males and 3% of females will develop one in their lifetime.11
Section snippets
Methods
The Westlaw database (West Publishing Co, St. Paul, MN) was queried for US civil trials conducted in the United States involving claims of medical malpractice in inguinal hernia surgery between 1991 and 2016. Verdicts and formal settlements published by 14 judicial sources are published in the database and encompass cases from all 50 states and the District of Columbia. The database does not include cases dropped before reaching a court docket. Sixty-seven case summaries were obtained using the
Results
Forty-six cases were identified in the 25-y time range. Age was missing from reports of 14 cases, and gender was missing from one report. The mean age of patients was 42 y, with a median of 42.5 y. Eighty percentage of patients in the study were male (Table 1). Overall, verdicts favored the defendants in 67% of cases (n = 31), for the plaintiff in 21.7% of cases (n = 10), and were settled in 10.9% of cases (n = 5). When a case favored the plaintiff, there was an average award of $1.49 million
Discussion
Inguinal hernia surgery appears to have a low incidence of medical malpractice claims. Although over 600,000 inguinal hernia surgeries are estimated to be completed each year, only 46 cases were discovered in our analysis.13 We did not identify any patient or case information that was associated with cases being successful (i.e., resulting in plaintiff award) or that were associated with the amount of monetary award. The most common injuries alleged were comparable with similar reviews
Conclusion
Litigation for hernia surgery appears uncommon. Annually, an estimated 28 repairs per 100,000 are performed28 but our search of a comprehensive US database yielded only 46 cases. However, these data do not include the number of cases settled out of court, dropped before trial, or dismissed during initial proceedings.
In addition, the likelihood of cases finding for the plaintiff is relatively low. When successful, the financial award for these cases can be substantial. Based on our review, there
Disclosure
The views expressed herein are of the authors and do not reflect the official policy of the Department of the Army, Department of Defense, or the US government. The authors report no conflict of interest—financial, personal, or professional—concerning the preparation of the article.
References (28)
- et al.
Surgical malpractice in the United States, 1990-2006
J Am Coll Surg
(2012) - et al.
Personal consequences of malpractice lawsuits on American surgeons
J Am Coll Surg
(2011) - et al.
Uncovering malpractice in appendectomies: a review of 234 cases
J Gastrointest Surg
(2013) - et al.
Medical malpractice and hernia repair: an analysis of case law
J Surg Res
(2013) - et al.
Evaluation of patient’s understanding and recall of the consent process after open inguinal hernia repairs
Int J Surg
(2012) - et al.
National costs of the medical liability system
Health Aff
(2010) - et al.
Defense costs of medical malpractice claims
N Engl J Med
(2012) - et al.
Malpractice risk according to physician specialty
N Engl J Med
(2011) The medical malpractice 'crisis': recent trends and the impact of state tort reforms
Health Aff (Millwood)
(2004)Medical liability reform
Litigation in laparoscopic cholecystectomies
Am Surg
National hospital discharge suvey: 2005 annual summary with detailed diagnosis and procedure data
Vital Health Stat 13
Public records privacy statement
Inguinal hernia repair surgery information from SAGES
Cited by (8)
Analysis of in court malpractice litigation following pancreatic surgery
2021, PancreatologySurgical management of chronic scrotal pain: a review of the current literature
2022, Minerva Urology and NephrologyMedical Malpractice Allegations in Nasal Turbinate Surgery
2021, American Journal of Rhinology and AllergyClinically Translatable Formulation Strategies for Systemic Administration of Nerve-Specific Probes
2021, Advanced TherapeuticsMedical Malpractice Litigation in Non-Mesh-Related Pelvic Organ Prolapse Surgery: An Analysis of 91 Cases
2021, Female Pelvic Medicine and Reconstructive SurgeryThe Incidence and Treatment Course of Patients with Chronic Postoperative Inguinal Pain Based on Patient-Reported Outcomes
2021, Japanese Journal of Gastroenterological Surgery