Pediatric neurosurgery malpractice claims in Germany

Thomas Beez, Hans-Jakob Steiger, Beate Weber, Sebastian Alexander Ahmadi

There is limited data regarding malpractice claims in pediatric neurosurgery. Aim of this study was to analyze the rate, subject, and outcome of malpractice claims faced by pediatric neurosurgeons. We analyzed malpractice claims in pediatric neurosurgical patients assigned to the review board of North Rhine Medical Council from 2012 to 2016. Claims were categorized as "medical error" or "adverse event, no medical error." Severity was graded from negligible (grade 1) to death (grade 6). Of 391 pediatric malpractice claims, seven (1.8%) concerned pediatric neurosurgery. Claims were related to cranial surgery (N = 5), spinal surgery (N = 1), and a neuro-interventional procedure (N = 1). Of operative cases, three were shunt operations, two were cranioplasty procedures, and one was a spinal fusion. Complications of medical care (adverse events) had occurred in all cases. A medical error was detected in only one case. Severity of damage was grade 2 (transient minor) in three, grade 3 (transient major) in one, and grade 5 (permanent major) in three cases, respectively. Pediatric neurosurgery accounted for 1.8% of all pediatric malpractice claims. In 14% of these claims, a medical error was confirmed. Malpractice claim rate thus appears to be lower than expected for a high-risk specialty. , adverse events were confirmed in all cases, a negligent medical error was rare. Adverse event rate appears to be a predictor for malpractice claim burden, highlighting the importance of surgical checklists, standard operating procedures and morbidity and mortality surveillance.