Plastic Surgery Closed Claims Study Reveals Most Common Case Types

Jacqueline Ross, RN, PhD, Coding Director, Department of Patient Safety and Risk Management, and Susan Shepard, MSN, RN, Senior Director, Patient Safety Staff Education

When it comes to medical malpractice claims, those involving plastic surgery are unique because surgeons perform both cosmetic and reconstructive surgery, involving patients with a very different set of expectations. In this study of plastic surgery closed claims, The Doctors Company looks at the most common case types, most common patient injuries, primary drivers / frequent allegations, and strategies for mitigating risk for both cosmetic and reconstructive surgery.

Study Design

The Doctors Company conducted a review of 415 claims (written demands for payment) against plastic surgeons that closed between July 2015 and December 2018. In examining closed medical malpractice claims, our team studies all aspects of each claim to capture the key clinical areas, understand the full scope of harm, determine whether the standard of care was met, identify contributing factors that led to patients’ injuries, and identify risk mitigation strategies that physicians can use to decrease the risk of injury, thereby improving the quality of care.

Results

• Procedures involving breast surgery made up 40 percent of all studied claims against plastic surgeons. The high percentage of claims is likely due to the volume of breast procedures performed by plastic surgeons and the need for an implant in many of these cases.
• Reoperations and emotional trauma made up two-thirds of all studied claims. While any surgery can end up requiring a revisional procedure, a poor initial patient assessment or an inadequate informed consent discussion regarding risks can lead to a lawsuit if reoperation is necessary. Unrealistic patient expectations can result in emotional trauma. Surgeons should help patients set reasonable expectations about outcomes, and have patients read, discuss, and sign consent forms from the American Society of Plastic Surgeons (ASPS).
• Only 26 percent of claims against plastic surgeons resulted in any indemnity payment. If plastic surgeons take the steps outlined in this study to reduce risks, this percentage could be even lower.
• Allegations of improper performance of surgery and improper surgical management drove three-quarters of plastic surgery claims. The allegation of improper performance of surgery often was made when a known complication occurred but the outcome differed from the patient’s expectations. In some cases, poor surgical judgment resulted in a complication that might have been avoided if a more traditional approach was used. Allegations of improper management arose when patients were not adequately prepared for surgery and/or when surgical complications were not managed effectively.
• Gluteal fat grafting, a.k.a. the “Brazilian Butt Lift,” is a risky procedure. Gluteal fat grafting has the highest death rate for any aesthetic procedure: as high as 1:3,000. Studied claims involving gluteal fat grafting were driven by improper performance of surgery. After conducting and documenting a thorough discussion of risks with the patient, surgeons should follow recommendations on gluteal fat grafting from the ASPS.

Conclusion

For plastic surgeons, especially, prior to any procedure, a complete informed consent discussion to establish shared expectations for outcomes can reduce the risk of a medical malpractice claim. Following an apparently successful procedure, close management helps to prevent many adverse events and being available to patients when there are questions or problems can help avoid claims when there is a complication.

Clinicians should hone strategies for risk reduction through careful patient assessment of and clear communication with patients. All parties benefit when clinicians set reasonable patient expectations about outcomes, discuss the possibility of complications and/or less-than-optimal results, and link back to these conversations when an undesirable outcome occurs.

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