What surgical procedures performed by general thoracic surgeons are most likely to be associated with lawsuits?

From the Guidelines

General thoracic surgeons face the highest litigation risk with lung resections, particularly lobectomies and pneumonectomies, as well as esophageal surgeries, especially esophagectomies, due to potential complications and injuries to adjacent structures 1.

Surgical Procedures and Litigation Risk

The highest quality study, published in 2017, highlights the importance of meticulous surgical technique and informed consent in reducing litigation risk 1.

• Lung resections, such as lobectomies and pneumonectomies, carry significant risks of complications, including bleeding, air leaks, bronchopleural fistulas, and respiratory failure.
• Esophageal surgeries, especially esophagectomies, represent a high litigation risk due to potential anastomotic leaks, strictures, and mediastinitis.
• Mediastinal procedures involving the thymus or lymph nodes also carry substantial litigation risk when they result in injury to adjacent structures like the phrenic nerve, recurrent laryngeal nerve, or major vessels.

Reducing Litigation Risk

To minimize litigation risk, general thoracic surgeons should:

• Perform thorough preoperative evaluations and detailed informed consent discussions.
• Employ meticulous surgical techniques, such as routine recurrent nerve visualization and dissection during thyroid and parathyroid surgery 1.
• Provide vigilant postoperative monitoring and comprehensive documentation of all patient interactions and decision-making processes.

Importance of Informed Consent

Informed consent is crucial in reducing litigation risk, as it ensures that patients are aware of potential complications and risks associated with surgical procedures 1.

• A study published in 2017 found that inadequate informed consent was a common factor in medical malpractice claims related to recurrent laryngeal nerve injuries during thyroidectomy 1.
• Surgeons should ensure that informed consent forms contain accurate descriptions of all potential complications, including rare but serious injuries.

From the Research

Surgical Procedures and Lawsuits

• General thoracic surgeons perform various surgical procedures, and some of these procedures are more likely to be associated with lawsuits due to their complexity and risk of complications.
• Esophagectomy, a surgical procedure to remove part of the esophagus, is one such procedure that can lead to complications like anastomotic leakage, which can result in lawsuits 2, 3, 4.
• Anastomotic leakage is a severe complication that can occur after esophagectomy, and it is associated with increased postoperative morbidity and mortality 2, 3, 4.
• The risk factors for anastomotic leakage after esophagectomy include higher body mass index, cervical anastomosis, diabetes mellitus type 2, and chronic obstructive pulmonary disease 4.

Comparison of Surgeon Specialties

• Studies have compared the outcomes of general thoracic surgeons and general surgeons in performing thoracic surgical procedures 5, 6.
• These studies have shown that general thoracic surgeons have better outcomes, including lower mortality and morbidity rates, compared to general surgeons 5, 6.
• However, the difference in outcomes may be more dependent on surgeon volume than subspecialty 6.

Complications and Lawsuits

• Complications like anastomotic leakage can lead to lawsuits, and identifying predictors of these complications can contribute to prevention and reduction of lawsuits 4.
• The consequences of anastomotic leakage include longer intensive care unit and hospital stay, higher percentage of patients dying within 30 days, and worse short-term outcomes 4.
• However, anastomotic leakage does not significantly influence long-term survival, and future studies should focus on patient optimization, accurate patient selection, and development of tools in risk assessment to reduce the risk of complications and lawsuits 4.