A 2014-2023 updated evaluation by the American Society of Metabolic and Bariatric Surgery of medical malpractice claims.

BACKGROUND

Metabolic and bariatric surgery (MBS) has achieved an excellent safety profile through robust quality standards. Closed claims analyses can identify vulnerabilities in MBS safety.

OBJECTIVES

To analyze medical malpractice claims and identify opportunities for improvement.

SETTING

University and private practice hospitals in the United States.

METHODS

Using Candello, a national database of medical professional liability claims, We studied closed claims involving MBS cases from 2014-2023. Cases were professionally coded and analyzed for total incurred cost (TIC), major responsible injury and allegation, injury severity, procedure type, and top contributing factors.

RESULTS

195 MBS cases (370 defendants) were identified, with a TIC of $52,294,474 ($297,128/case). Sleeve gastrectomy accounted for 25.1% of cases. High-severity injury or death occurred in 43%. The most common major injury was puncture/perforation (n = 31, 16%). Improper management represented 84% of TIC, with the most frequent injuries being dehiscence (n = 9), hemorrhage (n = 9), obstruction (n = 9), and sepsis (n = 7). The top contributing factors were technical skill (76%), clinical judgment (68%), and communication (38%). Among technical skill, 57% involved a known surgical complication, 15% poor technique, 5% retained foreign body, 2% positioning, 2% inexperience, and 2% misidentification of anatomy. Among the 46 deaths, 76% had an allegation of improper management of the surgical patient, with inappropriate procedure selection/management the top contributing factor.

CONCLUSIONS

Despite continued advancements in MBS, malpractice claim analysis highlights opportunities to improve technical skill, clinical judgment of managing complications, and communication among care teams.