Wrong-Side Procedures in Neurosurgery: A Detailed Review of Reported Events and Outcomes of Litigation in the Past 40 Years in the United States.

Abstract

To characterize malpractice claims, analyze the outcomes of litigation, and educate neurosurgeons on prevention and handling of wrong-side procedures in neurosurgery. A retrospective review of closed malpractice claims involving wrong-side cranial and spinal surgery surgeries was conducted utilizing WestLaw and LexisNexis legal databases and gray literature. Clinical and legal characteristics were collected, including patient demographics, type of surgeries, underlying pathology, legal details, and case outcome. Characteristics were compared using independent sample t-tests and chi-square tests. Of the initial 283 screened cases, 28 met the final inclusion criteria spanning from 1986 to 2023. Of 19 cases (68%) with known outcomes, 16 (84%) resulted in a plaintiff verdict. Most claims involved cranial surgery (n = 21, 75%). Among plaintiff outcomes with a documented payout value (n = 11, 44%), the median, inflation-adjusted award payout was $603,502 (range: $23,394-$37,298,104). The largest median payouts involved patients under 18 years old ($11,250,000). Only three outcomes in favor of the defendant were found, all of them based on procedural grounds and not involving the merits of the case. No significant differences were found between the incidence of wrong-side surgeries in the 20 years before and after the institution of the Universal Protocol in 2004. Statistical significance was found between the average award payout by practice setting (academic vs non-academic - P = 0.025). This descriptive analysis provides insight into the multifaceted character of malpractice litigation involving wrong-side procedures in cranial and spine surgery. Rulings on merit in favor of the defendant are exceedingly rare, while plaintiff outcomes typically involve very high awards, especially in the pediatric population. Effective management strategies such as prompt communication with family and hospital administration, early conflict resolution, and settlement consideration are advisable given the potential of serious negative publicity associated with such type of tragic and preventable events.