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
jamafacialplasticsurgery.com
Copyright 2017 American Medical Association. All rights reserved.
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