2017-18 HSC Section 4 Green Book

Original Investigation Research

Analysis of Rhytidectomy Malpractice Litigation Cases

Figure. Factors in Defendant Outcomes

Patient dissatisfaction

Facial nerve injury

P =.048

Postoperative negligence

Presence or absence of allegations led to changes in defendant outcomes. Compared with defendants without them, allegations of facial nerve injury (30% of cases with vs 63% of cases without injury; P = .048) and intraoperative negligence (52% of cases with vs 75% of cases without these allegations; P = .04) resulted in significantly lower rates of positive defendant outcomes.

Additional procedure(s) required

Without allegation With allegation

Inadequate informed consent

Poor cosmesis or disfigurement

P =.04

Intraoperative negligence

0

10

20

30

40

50

60

70

80

Positive Defendant Outcome, %

Table 1. Allegation Prevalence and Outcomes

Outcomes, % for Defendant With Allegation vs for Defendant Without Allegation

P Value

Allegation

Prevalence, No. (%)

Intraoperative negligence

61 (69) 57 (64) 30 (34) 14 (16) 12 (14) 10 (11)

52 vs 75 58 vs 63 63 vs 58 64 vs 59 77 vs 57 30 vs 63 67 vs 59

.04 .42 .39 .47 .14

Poor cosmesis or disfigurement Inadequate informed consent Additional procedures required

Postoperative negligence

Facial nerve injury

.048

Patient dissatisfaction with postoperative appearance

9 (10)

.47

Table 2. Allegation Characteristics and Outcomes for “Lifestyle Lift” Procedure a

Patient Dissatisfaction With Postoperative Appearance

Poor Cosmesis/ Disfigurement

Facial Nerve Injury

Inadequate Informed Consent

Intraoperative Negligence

Outcome Favored Award, $

Defendant

Defendant Defendant Defendant Defendant Defendant

NA NA NA NA NA

ENT ENT ENT

+ + − − − −

+ + + − − +

+ − + + + +

− − − − − −

− − − + − −

Facial plastic surgeon Facial plastic surgeon Facial plastic surgeon

Plaintiff

288 000

Abbreviations: ENT, ear, nose, and throat specialist; NA, not available; +, present; −, absent. a The lifestyle lift procedure involves tightening or oversewing the superficial muscular aponeurosis system layer. It often can be performed in less than 1 hour and can be done under local anesthesia.

involved negligence surrounding “Lifestyle Lift,” a proce- dure that tightens or oversews the superficial muscular apo- neurosis system layer (SMAS), and all but 1 of these cases re- solved in favor of the defendant ( Table 2 ).

[64%]), inadequate informed consent (30 [34%]), additional procedures required (14 [16%]), postoperative negligence (12 [14%]), and facial nerve injury (10 [11%]). Other cited factors in pursuing litigation were patient dissatisfaction with post- operative appearance (9 [10%]), pain (8 [9%]), hematoma (5 [6%]), numbness (5 [6%]), death (4 [5%]), and infection (3 [3%]). Only 2 allegations—facial nerve injury ( P = .048) and intraop- erative negligence ( P = .04)—had a significantly higher likeli- hood of being resolved with payment ( Figure and Table 1 ). Thirty-six cases (40%) involved combination procedures in which rhytidectomy was only 1 component. Six cases (7%)

Discussion Rhytidectomy is the sixthmost common cosmetic procedure in the United States, with an annual incidence of more than 120000 procedures. 26 A previous analysis 27 of MML related

(Reprinted) JAMA Facial Plastic Surgery Published online February 9, 2017

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