Neurosurgical Malpractice Litigation: A Systematic Review and Meta-Analysis

Introduction: Neurosurgery has one of the highest risks of medical malpractice claims. Through a systematic review and meta-analysis, we sought to compile all studies that investigated neurosurgical malpractice claims over the past twenty years and report factors and outcomes associated with neurosurgical malpractice litigation in the United States.

Methods: We conducted a systematic review of the literature according to PRISMA guidelines using the Medline, Embase, Cochrane, PubMed, and Google Scholar databases. We sought to identify pertinent studies containing information about medical malpractice claims and outcomes involving US neurosurgeons.

Results: We identified 16 retrospective studies spanning from 2002 to 2023, which reviewed over 7,890 malpractice claims involving practicing neurosurgeons in the United States. The most commonly filed claims were intraprocedural errors (37.4%), delayed diagnoses (32.1%), and failure to treat (28.8%). Less frequently filed claims included misdiagnosis or choice of incorrect procedure (18.4%), occurrence of death (17.3%), test misinterpretation (14.4%), failure to appropriately refer patients for evaluation/treatment (14.3%), unnecessary surgical procedures (13.3%), and lack of informed consent (8.3%). The defendant was favored in 44.3% of claims, while 31.3% of lawsuits were dropped, 17.7% of verdicts favored the plaintiff, and 16.6% of cases reached an out-of-court settlement. Only 3.5% of lawsuits found both parties liable.

Conclusion : Neurosurgery is a high-risk specialty with one of the highest rates of malpractice claims. Malpractice claims relating to spine surgery had a significantly higher rate of occurrence while cranial malpractice claims have been associated with a higher litigation compensation. Predictably, spinal cord injuries play a crucial role in predicting litigation, while non-surgical treatments are also a common source of liability in neurosurgical practice.