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Medical malpractice claims related to cataract surgery complicated by retained lens fragments (an American Ophthalmological Society thesis). Trans Am Ophthalmol Soc 2012 Dec;110:94-116

Date

07/03/2013

Pubmed ID

23818737

Pubmed Central ID

PMC3671368

Scopus ID

2-s2.0-84876546448   9 Citations

Abstract

PURPOSE: To review malpractice claims associated with retained lens fragments during cataract surgery to identify ways to improve patient outcomes.

METHODS: Retrospective, noncomparative, consecutive case series. Closed claims data related to cataract surgeries complicated by retained lens fragments (1989 through 2009) from an ophthalmic insurance carrier were reviewed. Factors associated with these claims and claims outcomes were analyzed.

RESULTS: During the 21-year period, 117 (12.5%) of 937 closed claims associated with cataract surgery were related to retained lens fragments with 108 unique cataract surgeries, 97% against cataract surgeon and 3% against retinal surgeon. Twelve (11%) of 108 claims were resolved by a trial, 30 (28%) were settled, and 66 (61%) were dismissed. The defendant prevailed in 83% of trials. Indemnity payments totaling more than $3,586,000 were made in 32 (30%) of the claims (median payment, $90,000). The difference between the preoperative visual acuity and the final visual acuity was predictive of an indemnity payment (odds ratio [OR], 2.28; P=.001) and going to a trial (OR, 2.93; P=.000). Development of corneal edema was associated with an indemnity payment (OR, 3.50; P=.037). Timing of referral and elevated intraocular pressure (IOP) were statistically significant in univariate analyses but not in multivariate analyses for a trial.

CONCLUSIONS: Whereas the majority of claims were dismissed, claims associated with greater visual acuity decline, corneal edema, or elevated IOP were more likely to result in a trial or payment. Ways to reduce significant vision loss, including improved management of corneal edema and IOP, and timely referral to a subspecialist should be considered.

Author List

Kim JE, Weber P, Szabo A

Authors

Judy E. Kim MD Professor in the Ophthalmology and Visual Sciences department at Medical College of Wisconsin
Aniko Szabo PhD Professor in the Institute for Health and Equity department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Adult
Aged
Aged, 80 and over
Cataract Extraction
Eye Foreign Bodies
Female
Humans
Insurance, Liability
Lens, Crystalline
Male
Malpractice
Middle Aged
Postoperative Complications
Retrospective Studies
jenkins-FCD Prod-482 91ad8a360b6da540234915ea01ff80e38bfdb40a