The American Society of Metabolic and Bariatric Surgery Closed-Claims Registry: Prevalence, Causes, and Lessons

Background

Bariatric surgery has demonstrated sustained improvements in quality. Malpractice closed claims have been offered as a means of assessing quality. Few studies have investigated malpractice closed claims and opportunities for improvement in bariatric surgery.

Objectives

To examine the prevalence and causes of malpractice claims with examination of prospects for quality improvement.

Setting

University Hospital; Private Practice; United States.

Methods

Four national malpractice insurers participated in the closed-claims registry. Data regarding patients, staff, procedures, and hospital status was gathered from closed-claims files. Following data collection, a clinical summary of each closed claim was collected, and later assessed by an expert panel on the basis of contributing diagnosis and treatment events; whether complications were potentially preventable by surgeon; the role of language, fatigue, distraction, workload, or teaching hospital/trainee supervision; communication concerns; and final care determination.

Results

175 Closed-claims were collected from index bariatric surgeries from 2006 to 2014. 75.9% of surgeons were Board Certified and 43.3% of the hospitals were accredited for bariatric surgery. Most clinical complications after bariatric surgery that led to malpractice lawsuits were mortality (35.1%), and leaks (17.5%). While they were not the common cause for malpractice suits, bleeding (5.3%), retained foreign body (5.3%) and vascular injury (4.4%) occurred at higher rates than national averages.

Conclusion

Prevalence of malpractice claims regarding bariatric surgery is low. Failure to diagnose, delay in treatment, postoperative care, and communication domain responses indicate future opportunities for improvement.