Neurosurgical practice liability: Relative risk by procedure type

BACKGROUND: Neurosurgeons have the highest exposure to litigation of all medical and surgical specialties. OBJECTIVE: To determine the relative risk of claims for compensation and indemnity by procedure type. The most common alleged factors and clinical outcomes are also determined. METHODS: The Physician Insurers Association of America Data Sharing Project was queried for all claims involving a neurosurgeon with an incident date during the calendar year 2006. Data were compared with the American Association of Neurological Surgeons National Neurosurgical Procedural Statistics 2006 Survey. Statistical analysis was performed using the x2 test and Fisher exact test as appropriate. RESULTS: Claims were most common after spine surgery, followed by medical management and cranial surgery. Compared with spine surgery, cranial surgery was significantly less likely to result in a claim (P , .0001, relative risk: 0.45). However, the average indemnity for spine surgery was 278 362 vs 423 539 for medical management and 438 183 for cranial surgery. The most common alleged factors in spine surgery were improper performance, wrong level operated on, and unindicated procedure. The most common alleged factors in medical management were errors in diagnosis and failure to monitor a patient. The most common alleged factors in cranial surgery were errors in diagnosis and improper performance. For all claims, the most common clinical outcomes were paraplegia, infection, other unspecified complications, and cauda equina syndrome. CONCLUSION: Claims are statistically less likely to occur after cranial surgery. However, indemnity is higher in cranial and medical management cases than in spine surgery cases. Nonsurgical treatment is a common source of liability in neurosurgical practice.