Abstract:
BACKGROUND:Sarcoma care is highly litigated in medical malpractice claims. Understanding the reasons for litigation and legal outcomes in sarcoma care may help physicians deliver more effective and satisfying care to patients while limiting their legal exposure. However, few studies have described malpractice litigation in sarcoma care. QUESTIONS/PURPOSES:(1) What percentage of sarcoma malpractice cases result in a defendant verdict? (2) What is the median indemnity payment for cases that result in a plaintiff verdict or settlement? (3) What are the most common reasons for litigation, injuries sustained, and medical specialties of the defendant physicians? (4) What are the factors associated with plaintiff verdicts or settlements and higher indemnity payments? METHODS:The national medicolegal database Westlaw was queried for medical malpractice cases pertaining to sarcomas that reached verdicts or settlements. Cases from 1982 to 2018 in the United States were included in the study to evaluate for trends in sarcoma litigation. Demographic and clinical data, tumor characteristics, reasons for litigation, injuries, and legal outcomes were recorded for each case. A univariate analysis was performed to identify factors associated with plaintiff verdicts or settlements and higher indemnity payments, such as tumor characteristics, defendant's medical or surgical specialty, reason for litigation, and injuries sustained. A total of 92 cases related to sarcomas were included in the study, of which 40 were related to bone sarcomas and 52 were related to soft-tissue sarcomas. Eighty-five percent (78 of 92) of cases involved adult patients (mean age ± SD: 40 ± 15 years) while 15% (14 of 92) of cases involved pediatric patients (mean age ± SD: 12.5 ± 5 years). RESULTS:Thirty-eight percent (35 of 92) of the included cases resulted in a defendant verdict, 30% (28 of 92) resulted in a plaintiff verdict, and 32% (29 of 92) resulted in a settlement. The median (interquartile range [IQR]) indemnity payment for plaintiff verdicts and settlements was USD 1.9 million (USD 0.5 to USD 3.5 million). Median (IQR) indemnity payments were higher for cases resulting in a plaintiff verdict than for cases that resulted in a settlement (USD 3.3 million [1.1 to 5.7 million] versus USD 1.2 million [0.4 to 2.4 million]; difference of medians = USD 2.2 million; p = 0.008). The most common reason for litigation was delayed diagnosis of sarcoma (91%; 84 of 92) while the most common injuries cited were progression to metastatic disease (51%; 47 of 92) and wrongful death (41%; 38 of 92). Malpractice claims were most commonly filed against primary care physicians (26%; 28 of 109 defendants), nononcology-trained orthopaedic surgeons (23%; 25 of 109), and radiologists (15%; 16 of 109). Cases were more likely to result in a ruling in favor of the plaintiff or settlement if a delay in diagnosis occurred despite suspicious findings on imaging or pathologic findings (80% versus 51%; odds ratio 3.84 [95% CI 1.34 to 11.03]; p = 0.02). There were no differences in indemnity payments with the numbers available in terms of tumor type, tumor location, defendant specialty, reason for litigation, and resulting injuries. CONCLUSIONS:Many lawsuits were made against primary care physicians, nononcology-trained orthopaedic surgeons, or radiologists for a delayed diagnosis of sarcoma despite the presence of imaging or histologic findings suspicious for malignancy. Although previous studies of bone and soft-tissue sarcomas have not shown a consistent association between time to diagnosis and decreased survival, our study suggests that physicians are still likely to lose these lawsuits because of the perceived benefits of an early diagnosis. CLINICAL RELEVANCE:Physicians can mitigate their malpractice risk while reducing delays in diagnosis of sarcomas by carefully reviewing all existing diagnostic studies, establishing closed-loop communication protocols to communicate critical findings from diagnostic studies, and developing policies to facilitate second-opinion consultation, particularly for imaging studies, with an experienced sarcoma specialist. Musculoskeletal oncologists may be able to help further reduce the rates of malpractice litigation in sarcoma care by helping patients understand that delays in diagnosis do not necessarily constitute medical malpractice.
journal_name
Clin Orthop Relat Resjournal_title
Clinical orthopaedics and related researchauthors
Hwang R,Park HY,Sheppard W,Bernthal NMdoi
10.1097/CORR.0000000000001340subject
Has Abstractpub_date
2020-10-01 00:00:00pages
2239-2253issue
10eissn
0009-921Xissn
1528-1132journal_volume
478pub_type
杂志文章abstract::This preliminary report outlines the rationale for a new approach to deep-vein thrombosis (DVT) prophylaxis in total knee arthroplasty (TKA) patients and describes preliminary hematologic and venographic findings. A protocol was employed to (1) document a series of hematologic events surrounding cemented TKA and the a...
journal_title:Clinical orthopaedics and related research
pub_type: 临床试验,杂志文章,随机对照试验
doi:
更新日期:1989-11-01 00:00:00
abstract::A massive solitary tophus containing calcium pyrophosphate dihydrate (CPPD) crystals was resected from the distal clavicle and proximal acromion of a 62-year-old man who presented with a painful shoulder mass. The diagnosis was confirmed histologically and by X-ray diffraction. CPPD crystal deposition was found within...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1988-02-01 00:00:00
abstract::A computer-assisted model has been developed to improve the results of surgical techniques for reconstruction of hip dysplasia. This method assesses the coverage and congruency of the femoral head by evaluating multiple factors that may influence surgical planning. It achieves a more reliable image because the measure...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1988-07-01 00:00:00
abstract::Anterior approaches to the ulna were studied on 22 cadaveric forearms as alternative approaches to the ulnar shaft. An anterior approach is indicated when there is extensive posterior scar tissue, or extensive soft tissue loss in the posterior forearm as in some fresh fractures, or when a tumor is resected from the an...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1995-09-01 00:00:00
abstract::Twelve cases of supracondylar fracture of the femur in rheumatoid arthritis patients with previously implanted resurfacing or MacIntosh arthroplasty of the knee had long standing severe polyarticular rheumatoid arthritis (duration, ten to 41 years; mean 24.8 years). The fractures occurred following a long interval aft...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1988-04-01 00:00:00
abstract::Malignant tumors around fracture fixation implants have been reported sporadically for many years. Recently, however, reports of sarcomatous degeneration around a standard cemented hip arthroplasty and around cobalt-chromium-bearing hip arthroplasties raise new questions of the malignant potential of metallic ends pro...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1987-03-01 00:00:00
abstract::The Hoffmann external fixator has proved to be an effective means of stabilizing complex femoral fractures in patients in whom prolonged traction or internal fixation is not advisable. It provides for the prompt mobilization of multiple-trauma victims and assists in the evaluation of the "floating knee." Pin tract inf...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1983-11-01 00:00:00
abstract::After spinal cord injury, excessive burden falls on the upper extremity, especially the shoulder. Overall, 51% of persons with spinal cord injury have shoulder problems. Common shoulder problems in persons with spinal cord injury begin with muscle imbalance that can lead to glenohumeral instability, impingement diseas...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章,评审
doi:10.1097/00003086-200210001-00004
更新日期:2002-10-01 00:00:00
abstract:BACKGROUND:There are few data on the types of procedures orthopaedic oncologists perform in their first years of practice. Because fellowships are graduating fellows each year and the number of tumor patients is limited, defining the practice patterns of early-career orthopaedic oncologists may help diminish early empl...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1007/s11999-014-3934-x
更新日期:2015-02-01 00:00:00
abstract::The management of premature physeal arrest requires accurate assessment of not only the location but also the extent of the bar. Numerous imaging techniques are available to evaluate the physis. Multiplanar tomography has proven to be the most precise method. The utility of magnetic resonance imaging (MRI) of physeal ...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1991-11-01 00:00:00
abstract::Protrusio acetabuli is common is rheumatoid arthritis. Progression of this deformity can be measured by serial roentgenograms. The inward progression of the femoral head is the result of upward migration of the acetabular roof and collapse of the femoral head which appears to occur in a ratio of approximately two to o...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1097/00003086-197505000-00012
更新日期:1975-05-01 00:00:00
abstract::Mesenchymal neoplasms are a heterogeneous group of tumors comprising more than 200 benign entities and approximately 100 sarcomas. Large intraobserver and interobserver variability mandates improvements in diagnostic criteria. Gene expression microarrays are one tool in an evolving field of technology that permits the...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1097/01.blo.0000093897.12372.88
更新日期:2003-10-01 00:00:00
abstract::Contemporary management of Grade IIIB open tibial fractures has evolved to include intravenous antibiotics, thorough interval surgical debridement, rigid skeletal fixation, early local or free tissue myoplasty, and liberal use of autogenous bone graft beneath a clean, stable wound. External fixation has been the skele...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章,meta分析
doi:10.1097/00003086-199611000-00003
更新日期:1996-11-01 00:00:00
abstract::The purpose of this study was to examine the mating surfaces of femoral heads and stems for evidence of corrosion, and to evaluate the quality of the taper lock of modular hip prostheses. Forty-eight implants with three different designs were evaluated. Group I (26 implants) had a cobalt alloy head and cobalt alloy st...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1994-03-01 00:00:00
abstract::A ball-and-socket joint is an unusual disturbance of normal ankle development. Previous reports have noted good function and the absence of osteoarthritic change in ankles with this configuration. A 50-year-old man with no history of injury developed an osteoarthritic ball-and-socket deformity of the ankle joint. Asso...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1987-02-01 00:00:00
abstract::Long-term results of total hip replacement by low-friction arthroplasty show a consistent and reproducible outcome for relief of pain, increased mobility, and function in most patients followed for five to 15 years after surgery. In a review of 1009 consecutive operations, the rate of reoperation and potential failure...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1987-12-01 00:00:00
abstract::The choice of pin site in shoulder arthrodesis after brachial plexus injury is important for efficient external fixation. The pins are inserted into the coracoid process from the anterior aspect and the scapular spine from the acromion. This insertion method holds the scapula more rigid and allows the patient to lie s...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1989-10-01 00:00:00
abstract::Design of a synthetic replacement or selection of a biologic substitute requires detailed knowledge of the mechanical properties of the normal ligament. Femur-anterior cruciate ligament-tibia unit (ACL) data have been frequently used for this purpose, although not always properly. Mechanical properties of the human AC...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章,评审
doi:
更新日期:1985-06-01 00:00:00
abstract::The mechanism of injury and long-term effects in three cases suggest that a specific type of intercondylar injury of the femur, i.e., cleavage fracture, is caused by force transmitted through the patella. Treatment is conservative. The fracture does not appear to have been mentioned previously in the English literatur...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1981-10-01 00:00:00
abstract::Fracture-healing problems today occur predominantly in the weight-bearing tibia and femur. This review of 83 lower-limb nonunions out of a series of 100 fracture-healing problems identified avoidable causes in 30%. These included rigid fixation, which produced fracture gap, fibulectomy, which destabilized the tibia, a...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1985-04-01 00:00:00
abstract::This study determined whether patients with severe knee disease below a hip arthrodesis can be treated successfully with total knee replacement alone or whether such patients require total hip arthroplasty followed by knee replacement. Eighteen patients who had hip arthrodesis for a mean of 33 years underwent total hi...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1097/00003086-200002000-00017
更新日期:2000-02-01 00:00:00
abstract::Numerous studies document vibrations emanating from joints during active or passive motion. It has been proposed these vibrations, termed vibroarthrographic signals, are associated with changes in the shape or quality of tissues in and around the joint. Vibroarthrographic signals in articular joints have been tested t...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1097/BLO.0b013e31802c3423
更新日期:2007-03-01 00:00:00
abstract::The effect of electromagnetic field stimulation was investigated in a group of 40 consecutive patients treated with valgus tibial osteotomy for degenerative arthrosis of the knee. All patients were operated on by the same author and followed the same postoperative program. After surgery, patients were randomly assigne...
journal_title:Clinical orthopaedics and related research
pub_type: 临床试验,杂志文章,随机对照试验
doi:
更新日期:1993-03-01 00:00:00
abstract:UNLABELLED:The treatment of 30 consecutive adult patients with chronic draining osteomyelitis of the tibia was reviewed. There were four treatment patterns. Eight patients had local debridement with or without soft tissue coverage procedures or bone graft. Three patients had radical debridement and bone transport using...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1097/01.blo.0000150462.41498.fe
更新日期:2005-04-01 00:00:00
abstract:BACKGROUND:Bacteria shed by operating room personnel is a source of wound contamination and postoperative infections. The personal protection system (PPS) was designed to decrease airborne bacteria and intraoperative contamination in total joint arthroplasty. QUESTIONS/PURPOSES:We determined the microbial contaminatio...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1007/s11999-011-1883-1
更新日期:2011-11-01 00:00:00
abstract::Tuberculosis was first described in 1756 by Acrel in a case report. Subsequent reports of musculoskeletal tuberculosis documented the uncommon occurrence of hand and wrist involvement. The two cases presented here demonstrate the difficulty in eradicating the organism even with modern regimens of chemotherapy. Intraop...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1991-01-01 00:00:00
abstract::The geometric total knee prosthesis was used in the reconstruction of 70 damaged knee joints in 56 patients from November 1973 through March 1979. The average follow-up period extended to six years and seven months. Eleven patients had died and four could not be located. Eighty-one percent of the remaining knees had l...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1986-01-01 00:00:00
abstract:BACKGROUND:Adverse local tissue reactions (ALTR) around metal-on-metal (MOM) hip arthroplasties are increasingly being recognized as a cause of failure. These reactions may be associated with intraoperative tissue damage and complication rates as high as 50% after revision. Although MRI can identify ALTR in MOM hips, i...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1007/s11999-013-2788-y
更新日期:2014-02-01 00:00:00
abstract::Antibiotic prophylaxis is indicated only under specific surgical settings. Appropriate antibiotic prophylaxis must take into account the type of surgery, the competence of the host, and the pharmacologic properties of the antibiotic(s). The antibiotic should be given before the surgical procedure and have an antibacte...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1984-11-01 00:00:00
abstract::The right hips of 69 five-day-old rabbits were dislocated surgically and left to develop in the dislocated position to determine the nature and timing of changes in the hip. Using the left hips as controls, 15 survivors were killed and studied macroscopically and microscopically at two months of age and 14 at four mon...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1982-11-01 00:00:00