Trends and contributing factors in medicolegal cases involving cranial surgery in Canada

Abstract

Objective: Neurosurgery is a high-risk specialty with a low margin of error, and neurosurgeons have a higher medicolegal risk than practitioners in many other specialties. The aim of this study was to provide a current medicolegal landscape of cranial surgery in Canada.

Methods: In this retrospective descriptive study, the authors evaluated 10 years (2012-2021) of cranial neurosurgical data on closed legal actions, medical regulatory authority (College) cases, and hospital complaints against neurosurgeons that had been submitted to the Canadian Medical Protective Association (CMPA). Only cranial cases, even those involving ventriculoperitoneal shunt (VPS) placement or catheter or wire insertion in the brain, were eligible for study inclusion. Excluded cases were those involving pediatric patients and angiography, radiation, ultrasound, or percutaneous procedures.

Results: Seventy-six cranial cases were included in the study. Neurosurgeons had a significantly higher medicolegal risk compared to that of the overall CMPA surgeon membership. Civil legal actions accounted for more than half of all the cranial cases. Fifty-four percent of cases involved postoperative complications, and 21% involved VPS placement. Communication issues were commonly named factors leading to a medicolegal complaint throughout the data.

Conclusions: This is the first report on the Canadian experience of medicolegal cranial surgery cases. These cases most commonly involved tumor excision, VPS insertion, and decompressive craniectomy. The VPS cases were unexpectedly common and should be further investigated. A breakdown in communication was a major theme in the medicolegal data repository.

Keywords: cranial; medicolegal; neurosurgery; neurosurgical education; surgical technique.