Malpractice Claims in Plastic Surgery: Descriptive-Comparative-Predictive

PURPOSE: Plastic Surgeons face unique issues with professional liability claims due to the nature of plastic surgery practice, in particular the mix of both reconstructive and cosmetic procedures. The relatively rare occurrence of a malpractice claim for any individual plastic surgeon makes it unlikely that techniques to reduce malpractice risk are evident. In this analysis we looked at ten-years of malpractice claims filed against plastic surgeons insured through The Doctors Company Group (TDCG). All claims and suits filed against TDCG insured plastic surgeons from 2009 to 2021 were analyzed and compared with claims against surgeons in other specialties over the same time frame. Data was stratified according to several different variables including patient demographics, case type, injury, and contributing factors/risk management issues. A logistic regression analysis was performed to identify those variables associated with medical malpractice payments. Of the 1,708 claims against plastic surgeons, 90% were on behalf of female patients, and the average age of a claimant was 45 years old. Comorbidities of claimants included smoking in 6.9% and obesity in 6.4%. Ninety-two percent of claimants had ambulatory surgery or a procedure. The top three surgeries in claims were breast reduction (21.8%), breast augmentation (17.2%), and breast reconstruction (11.8%). When compared to 7,202 non-plastic surgery claims, plastic surgery claims were more likely to concern the surgery itself (53.8% v 41.3%, p<.001), or the performance of a procedure (9.4% v 4.7%, p<.001). Non-plastic surgery claims were more likely to be diagnosis related (11.3% v 1.8%, p<.001). Cosmetic injury was most common in cosmetic breast surgery claims - augmentation (33.3%), and lift (28.1%), compared with reconstructive breast surgery claims - reconstruction (19.4%), and reduction (14.8%). Need for additional surgery was most common in claims involving breast reconstruction (52.7%). Contributing factors including selection of procedure or therapy, poor technique, and known complications were present in 86% of the plastic surgery claims compared with 91% of the non-plastic surgery claims (p<.001). In 38.8% of plastic surgery claims patients sought other providers due to dissatisfaction with their surgeon, a factor in only 17.1% of non-plastic surgery claims (p<.001). Factors that might have helped to preclude the bringing of a lawsuit typically involving communication with patients and family, were more common in plastic surgery claims (59.4%) than in non-plastic surgery claims (36.6%, p<.001). Specifically, there were unmet expectations in 14.4% of plastic surgery claims, but in only 3.8% of non-plastic surgery claims (p<.001). A similar percentage of non-plastic surgery claims closed with no indemnity payment (26.6%) as plastic surgery claims (25.3%) but there was a 3.7 times greater likelihood of a plastic surgery claim closing with payment when a documentation issue was present. This analysis points to the issues confronting plastic surgeons when considering malpractice risk reduction. Managing patient expectations is critical, especially when patients undergo cosmetic surgery. Breast surgery is the most litigious group of procedures plastic surgeons perform, and good documentation is more likely to result in no payment being made when there is a claim.