Magnitude and Determinants of Defensive Medicine Among Neurosurgeons in Saudi Arabia: A National Cross-Sectional Study.

Abstract

This study investigates defensive behavior among neurosurgeons in Saudi Arabia. No previous studies have explored defensive medicine among neurosurgeons in the Middle East. A 41-item self-administered questionnaire was sent to 175 consultant neurosurgeons via the Saudi Association of Neurological Surgery network. The survey comprised 8% domains: surgeon demographics, patient characteristics, type of practice, insurance, liability profile, reimbursement, defensive behavior, and perception of liability environment. A defensive medicine score (0-100) quantified responses. Participants scoring 50%-70% were classified as low, 71%-90% as moderate, and >90% as high practice. Multivariate linear regression was performed. A total of 141 neurosurgeons completed the survey (response rate, 81%). Most participants were male (94%). Spine certification was present in 30%, but exclusive spine practice was rare (5%). About half (53%) had prior malpractice complaints. Liability was confirmed in 2.8%. The prevalence of defensive medicine was 21% for positive practices (low 17%; moderate 2.8%), 7.1% for negative (low 6.4%; moderate 0.7%), and 7.8% for total practices (low 7.1%; moderate 0.7%). Fear of litigation was the only independent predictor of defensive medicine scores: total (β = 2.13, 95% CI: 1.17-3.10; P < 0.001), positive (β = 1.04, 95% CI: 0.57-1.51; P < 0.001), and negative (β = 1.41, 95% CI: 0.69-2.12; P < 0.001). Positive defensive medicine was more prevalent than negative or total practices. Defensive behavior was primarily low-to-moderate. Fear of litigation was the only independent predictor of defensive medicine scores. Intensive mitigation strategies should prioritize moderate-to-high-practice neurosurgeons.