Abstract
Background
Surgical patients have cost the NHS 1.3 billion GBP from 1995. Spinal pathologies can present diagnostic challenges, and the consequences of delayed diagnosis or surgical complications can be devastating and so creating high indemnity costs.
We aim to highlight the spinal associated litigation patterns within the United Kingdom.
Method
Data was obtained from the NHS Litigation Authority from 2002 to 2010.
Result
From 236 claims, 144 were related to trauma or acute diagnostic issues and 92 from elective surgery. The financial burden to the NHS came to 60.5 million GBP. Of this sum 42.8 million GBP were paid in damages, and the remaining 29% in legal costs. The financial costs were similar for trauma and elective cases. The most frequent cause of successful litigation for trauma were, missed fractures(41.7%), missed cauda equina(23.6%) and spinal infection(11.8%). The emergency department(43.8%), orthopaedic surgery(28.5%) and Medicine(13.9%) bore the brunt of the claims.
For elective surgery, Spinal Damage(19.8%), failure in Post-Operative Care(15.4%), Infection(11%) and Wrong Level Surgery, Cauda Equina and Surgical Failure(9.9% each). were likely to result in a successful claim, and the litigation burden was felt by the orthopaedic(60.4%), Neurosurgery(18.7%) and other surgical disciplines(11%).
Conclusion
Acute spinal fractures, cord compression and infection should be considered in patients in the emergency department setting, with appropriate examination and investigations for uncertainty. A lack of awareness of at risk cases increases the likelihood of a pay-out and sums involved. For elective spinal surgery, a failure in the consenting process and the technical skill of the surgeon are likely to result in a pay-out. A failure to identify post-operative complications such as infection and thromboembolism are also indefensible.
Protecting patients intra-operatively and maintaining high technical expertise and vigilance post-operatively in an adequately consented patient may decrease litigation rates.
