RS17 - Things Are Getting Tight: A Comprehensive Analysis of Medical Malpractice Claims Related to Fasciotomy

Objectives: Acute compartment syndrome is a limb threatening emergency often requiring fasciotomy. Delayed diagnosis and treatment can lead to severe morbidity, limb loss, and even mortality. Adverse patient outcomes and medical errors can trigger legal redress. Few studies have examined medicolegal outcomes related to fasciotomy and management of compartment syndrome. Using a large legal database, we evaluated reasons for medical litigation related to fasciotomy.

Methods: Westlaw® (Thompson Reuters), an online legal dataset was queried for all medical malpractice cases from 1978 to 2020 reported in the United States. Records were included from all state and federal jurisdictions related to compartment syndrome and fasciotomy. Only cases where the alleged reason for litigation was directly related to the diagnosis, management, and the procedure if performed were included in our final analyses. We excluded all duplicate cases and cases where the primary legal action was not related to management of the compartment syndrome. Data was collected on patient/case characteristics, procedural variables, defendant information, alleged reason(s) for litigation, and case/trial outcome(s).

Results: The search criteria yielded 392 case briefs. Two hundred and eighty-nine cases (74%) cases met inclusion criteria. Mean (±SD) patient age was 35±19 years; 175(61%) patients were male. Failure to obtain informed consent was documented in 12(4%) of cases. Vascular surgeons were implicated as defendants in 26(9%) of cases. The most common reason for litigation was delayed diagnosis of acute compartment syndrome leading to a delay in management 173 cases (60%); p< 0.05. California had the highest number of reported cases 46(16%) followed by Florida 29(10%). An outcome in favor of the defendant was reached in 167(57%) cases; Table 1. Median plaintiff award payout was $750,000. There was no statistically significant difference between settlement/arbitration and plaintiff award payouts; p>0.05.

Conclusions: Compartment syndrome and fasciotomy have led to a significant number of legal claims over the last 40 years with orthopedic surgeons being the most frequently named defendants and vascular surgeons implicated in 9% of cases. Although a majority of cases were decided in favor of the defendant, settlements and plaintiff verdicts were costly. Delayed detection of compartment syndrome and failing to perform a fasciotomy was the most common reason for litigation. These medicolegal findings further support the clinical axiom of identifying and addressing compartment syndrome in a timely and effective manner.