All Trauma Surgeons Are Not Created Equal: Asymmetric Distribution of Malpractice Claims Risk

Abstract

Trauma surgery is perceived to have high malpractice risk. Unsolicited patient complaints (UPCs) can predict increased malpractice risk. An ex ante analysis of UPCs was performed to determine the risk profile for trauma surgeons compared with nontrauma surgeons. UPCs from 14 health systems over 4 years were retrospectively studied. Surgeons were divided into nontrauma surgeons (NTS) and trauma surgeons (TS). Inclusion criteria for TS were practice at a Level I or geographically isolated Level II adult trauma center and either surgical critical care certification or American Association for the Surgery of Trauma, Eastern Association for the Surgery of Trauma, or Western Trauma Association membership. Standardized risk scores were generated using a weighted sum algorithm from UPC data. Mann-Whitney U test, Kolvogorov-Smirnov two-sample test for distribution, χ for linear trend, and relative risk analysis were performed. A total of 16,518 UPCs were filed against 4,244 surgeons, including 55 TS. 18% of TS and 57% of NTS had 0 UPCs. Mean risk score was higher for TS (29.2 ± 29.0 vs. 10.2 ± 19.5, p < 0.001), and more TS (20.0% vs. 3.15%) were at moderate (score 50-69) or at high risk (score >70) (7.27% vs. 2.57%; p < 0.001), reflecting a shifted risk distribution (p < 0.001) compared with NTS. TS have a relative risk of 6.17 (95% CI: 3.36-11.33) for score >50. TS are at increased risk of UPCs compared with NTS, but this risk is still largely borne by a minority of TS. UPCs seem to be a reasonable proxy for malpractice risk, so targeted interventions for TS associated with disproportionate shares of UPCs may reduce patient dissatisfaction and, perhaps, malpractice claims.