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Image-guidance in endoscopic sinus surgery: is it associated with decreased medicolegal liability?

Authors

  • Jean Anderson Eloy MD, FACS,

    Corresponding author
    1. Department of Otolaryngology–Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ
    2. Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, NJ
    3. Center for Skull Base and Pituitary Surgery, Rutgers New Jersey Medical School, Newark, NJ
    • Correspondence to: Jean Anderson Eloy, MD, FACS, Department of Otolaryngology–Head and Neck Surgery, Rutgers New Jersey Medical School, 90 Bergen St., Suite 8100, Newark, NJ 07103; e-mail: jean.anderson.eloy@gmail.com

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  • Peter F. Svider MD,

    1. Department of Otolaryngology–Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ
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  • Christine M. D'Aguillo BA,

    1. Department of Otolaryngology–Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ
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  • Soly Baredes MD, FACS,

    1. Department of Otolaryngology–Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ
    2. Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, NJ
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  • Michael Setzen MD, FACS,

    1. Rhinology Section, North Shore University Hospital, Manhasset, NY
    2. Department of Otolaryngology, New York University School of Medicine, New York, NY
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  • Adam J. Folbe MD

    1. Department of Otolaryngology–Head and Neck Surgery, Wayne State University School of Medicine, Detroit, MI
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  • Potential conflict of interest: M.S. is a speaker for TEVA and MEDA on their Speakers Bureau (not related to current subject); the other authors have nothing to report.

Abstract

Background

The use of image-guidance (IG) in endoscopic sinus surgery (ESS) has escalated over the last decade despite a lack of consensus that its use improves outcomes or decreases complications. One theoretical reason for using IG in ESS is its potential to minimize legal liability should an adverse outcome occur. In this study, we aimed to characterize the role of IG in ESS litigation, and further detail other factors in pertinent cases. A secondary objective was to characterize recent malpractice litigation for other relevant factors.

Methods

Relevant cases from Westlaw were examined to determine whether the use of IG played a role in initiating litigation in ESS malpractice suits. Factors such as patient demographics and alleged cause(s) of malpractice litigation were examined.

Results

Out of 30 malpractice cases from 2004 to April 2013, 4 (13.3%) mentioned the use of IG during ESS, although this did not appear to be a factor affecting the plaintiff's decision to initiate litigation, nor the case outcomes. In the 26 cases (86.7%) in which IG was not used, its non-use was not specified as an alleged cause of negligence. Eleven (36.7%) cases were resolved in the defendant's favor. Frequently-cited factors included iatrogenic injury (83.3%), permanent deficits (66.7%), needing additional surgery (63.3%), orbital and intracranial injury, and perceived deficits in informed consent (40.0%).

Conclusion

The use of IG was not found to be a factor in ESS litigation. This suggests that not using IG does not necessarily make one more vulnerable to malpractice litigation.

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