Quality improvement lessons from Canadian thyroid and parathyroid surgery legal decisions

• Published in: The American journal of surgery Vol. 235; p. 115747
• Main Authors: Schweitzer, Christina L., Garcha, Ivneet, Wiseman, Sam M.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-09-2024; Elsevier Limited
• Subjects: Adult; Aged; Canada; Case law; Clinical medicine; Databases, Factual; Decisions; Female; Humans; Legal information; Litigation; Male; Malpractice; Malpractice - legislation & jurisprudence; Medical malpractice; Middle Aged; Ostomy; Parathyroid; Parathyroidectomy; Parathyroidectomy - legislation & jurisprudence; Patient safety; Physicians; Quality control; Quality Improvement; Risk assessment; Surgeons; Surgery; Thyroid; Thyroid gland; Thyroidectomy; Thyroidectomy - legislation & jurisprudence; Tribunals & commissions; Canada; United States > US; Canada; Quality improvement; Parathyroidectomy; Thyroidectomy; Malpractice; Litigation
• ISSN: 0002-9610; 1879-1883; 1879-1883
• DOI: 10.1016/j.amjsurg.2024.04.018

This is the first study of Canadian thyroid and parathyroid surgery legal decisions, and the first study of surgical malpractice using the Canadian Legal Information Institute (CanLII) database. The objective was to identify quality improvement opportunities in surgical practice, to increase patient safety and satisfaction.
Legal decisions relating to thyroid and parathyroid surgery in the CanLII database were screened. Cases were included if a surgeon was listed as applicant or respondent; they related to pre-, intra-, or post-operative management of thyroid or parathyroid disease; and malpractice was alleged. Cases were excluded if surgery was mentioned incidentally or for non-surgical focus.
Of the 347 unique legal decisions screened, 14 met inclusion and exclusion criteria. Surgeries occurred between 1976 and 2012, with 13 thyroid surgeries, 1 parathyroidectomy, and 4 mortalities.
Quality improvement lessons include communication, pre-operative patient education and documentation of risks discussed, and in-person assessment of complications.
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•The first review of thyroid and parathyroid surgery malpractice cases in Canada.•14 thyroid surgery and 1 parathyroid surgery malpractice cases were identified.•Complications include death, hematoma, nerve injury, and unnecessary surgery.•Communication, timely follow-up and assessment, and documentation can be improved.•Recommendations could improve patient safety, satisfaction, and reduce litigation risk.