gms | German Medical Science

Objective: Malpractice claims affect surgeons worldwide. However, limited data on malpractice is available for neurosurgeons in Germany. We analyzed the rate, subject and outcome of malpractice claims faced by neurosurgeons in one of the largest medical council coverage areas in Germany, representing 60,000 physicians and 10 million inhabitants.

Methods: We analyzed all malpractice claims regarding neurosurgical procedures that were completed by the arbitration board of the North Rhine Medical Council (NRMC) from 2012-2016. Claim merit, content and actual treatment errors were reviewed. Severity of damage was graded from negligible (1) to death (6).

Results: 8,381 malpractice cases were reviewed by the NRMC from 2012-2016. 305 cases (3.6%; 149 females, 156 males) pertained to patients undergoing neurosurgical treatment, thereof 88.2% in-hospital, 11.8% as outpatients. Malpractice claims most frequently involved spinal surgery (216, 70.8%) followed by cranial surgery (82, 26.9%) and other treatments (7, 2.3%). Of 305 cases arbitrated, actual treatment errors were found in 72 cases, but only 63 of these (20.7% of all cases) had neurosurgeons as primary or secondary provider. Patients most frequently underwent neurosurgical treatment for spinal degenerative disease (33 patients, 52.4%), chronic / radicular pain, cranial tumors, and hydrocephalus with 7 cases each (33.3%). Trauma, infections and spinal tumors made up the remainder of cases (14.3%). Errors involved postoperative treatment in 22%, actual surgical treatment in 42%, indications and pre-operative workup in 32%, and patient consent in 4%. In 50 of 63 cases, type 1 medical error was found, with light and/or temporary damage found in 48%, negligible to moderate but permanent damage was found in 38%. 7 patients suffered severe and permanent damage (14%).

Conclusion: Neurosurgery claims made up 3.6% of all claims arbitrated by the NRMC in the past 5 years. 63 claims (20.7%) were deemed justified and primarily or secondarily neurosurgical. The majority of treatment errors did not involve surgery itself (42%), but occurred during workup, indication and consent (36%) and during post-operative care (22%). Understanding the distribution and content of claims is a key for improving patient satisfaction not only by honing surgical skills, but also by improving pre- and post-operative communication and care.