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Surgical never events in the United States

  • Winta T. Mehtsun
    Affiliations
    Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD

    Department of Health Policy and Management, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD

    Department of Biostatistics, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD

    Department of Surgery, Massachusetts General Hospital, Boston, MA
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  • Andrew M. Ibrahim
    Affiliations
    Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD

    Department of Surgery, University Hospitals Case Medical Center, Cleveland, OH
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  • Marie Diener-West
    Affiliations
    Department of Biostatistics, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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  • Peter J. Pronovost
    Affiliations
    Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD

    Department of Health Policy and Management, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD

    Department of Anesthesiology/Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD
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  • Martin A. Makary
    Correspondence
    Reprint requests: Martin A. Makary, MD, MPH, Department of Surgery, The Johns Hopkins University School of Medicine, Osler 624, 600 N. Wolfe St., Baltimore, MD 21287.
    Affiliations
    Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD

    Department of Health Policy and Management, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
    Search for articles by this author
Published:December 18, 2012DOI:https://doi.org/10.1016/j.surg.2012.10.005

      Background

      Surgical never events are being used increasingly as quality metrics in health care in the United States. However, little is known about their costs to the health care system, the outcomes of patients, or the characteristics of the providers involved. We designed a study to describe the number and magnitude of paid malpractice claims for surgical never events, as well as associated patient and provider characteristics.

      Methods

      We used the National Practitioner Data Bank, a federal repository of medical malpractice claims, to identify malpractice settlements and judgments of surgical never events, including retained foreign bodies, wrong-site, wrong-patient, and wrong-procedure surgery. Payment amounts, patient outcomes, and provider characteristics were evaluated.

      Results

      We identified a total of 9,744 paid malpractice settlement and judgments for surgical never events occurring between 1990 and 2010. Malpractice payments for surgical never events totaled $1.3 billion. Mortality occurred in 6.6% of patients, permanent injury in 32.9%, and temporary injury in 59.2%. Based on literature rates of surgical adverse events resulting in paid malpractice claims, we estimated that 4,082 surgical never event claims occur each year in the United States. Increased payments were associated with severe patient outcomes and claims involving a physician with multiple malpractice reports. Of physicians named in a surgical never event claim, 12.4% were later named in at least 1 future surgical never event claim.

      Conclusion

      Surgical never events are costly to the health care system and are associated with serious harm to patients. Patient and provider characteristics may help to guide prevention strategies.
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