110 Trends and Risk Factors for Medical Malpractice Litigation in Open Cranial Neurosurgery

INTRODUCTION: Neurosurgery is the most litigious specialty amongst all specialties across medicine. Understanding the reasons for malpractice claims can help inform neurosurgeons improve care and mitigate litigation risk. METHODS: The Westlaw Edge and LexisNexis databases were searched for cases involving medical malpractice claims due to cranial surgery between the years 1985-2023. Data collected included case date, verdict ruling, jurisdiction, sustained injuries, and awards or settlement amounts. RESULTS: Of 1546 cases reviewed, 317 were identified as malpractice claims resulting from cranial surgery. The primary causes for litigation were perioperative complications (n=115), delayed or denied treatment (n = 95), insufficient follow-up care (n = 51), inappropriate procedure selection (n = 39), and inadequate informed consent (n = 8). Tumor surgery had the highest number of claims (n = 81), followed by vascular (n = 59), trauma (n = 54), infection (n = 43), functional/epilepsy (n = 28), and other/not defined (n = 56). Regarding verdict ruling, 39.4% (n = 125) ruled in favour of the defendant; 20.5% (n = 65) in favour of the plaintiff; 2.2% of verdicts resulted in mixed ruling (n = 7); in 10.7% (n = 34) of claims were resolved in an out-of-court settlement; and in 27.1% (n = 86) the verdict was not available. The subspecialty with the highest proportion of plaintiff verdicts was tumor 29.2%, (n = 19), and tumor also had the highest proportion of defendant verdicts 26.40%, (n = 33). The average verdict amount awarded to plaintiffs was $5,592,703, while the average settlement amount was $2,751,807. CONCLUSIONS: The authors highlight several risk factors for medical malpractice claims across cranial neurosurgery. These results suggest that litigation may be mitigated with accurate and timely diagnosis, timely referrals and coordinated care.