Title :

Management of symptomatic postoperative epidural hematoma in spine surgery: Medicolegal implications.

Author(s) :

Leroy, Henri-Arthur [Auteur]
Portella, T. [Auteur]
Amouyel, Thomas [Auteur]
Bougeard, R. [Auteur]
Assaker, Richard [Auteur]
Protéomique, Réponse Inflammatoire, Spectrométrie de Masse (PRISM) - U1192
Mourier, K. L. [Auteur]

Journal title :

Orthopaedics & Traumatology: Surgery & Research

Abbreviated title :

Orthop Traumatol Surg Res

Pages :

103024

Publication date :

2021-08-08

ISSN :

1877-0568

English keyword(s) :

Epidural hematoma
Spine surgery
Neurologic deficit
Complications
Expert review
Medicolegal

HAL domain(s) :

Sciences du Vivant [q-bio]

English abstract : [en]

Introduction: Spine surgery is one of the specialties with the highest medicolegal risk, with a legal action initiated every 17 months per practitioner. One of the most dreaded complications is an epidural hematoma with ...
Show more >Introduction: Spine surgery is one of the specialties with the highest medicolegal risk, with a legal action initiated every 17 months per practitioner. One of the most dreaded complications is an epidural hematoma with postoperative deficit. The treatment ofthis complication is still being debated. We therefore conducted a retrospective study of the database of a medical liability insurer to assess perioperative factors determining the liability of the surgeon or paramedical team during an expert review in the event of a postoperative symptomatic epidural hematoma. Hypothesis: To identify the factors determining the liability of the medical team in the event of a postoperative symptomatic epidural hematoma. Materials and Methods: We retrospectively analyzed the largest French register of medicolegal expert reviews between 2011 and 2018. We identified 68 cases by entering the following keywords in this database: “spine surgery,” “complications,” and “epidural hematoma.” After a thorough review of each case, only 14 were deemed to be truly relevant to our study. We collected for each patient the perioperative data, complications (including neurologic deficits) and their clinical course. Results: Only one surgeon was accused and found liable for failing to perform a surgical revision within a reasonable timeframe (time to revisionof11days).In2cases,the liability of anurse working inthe surgical department was called into question for failing to contact the surgeon upon the onset of symptoms. In the other cases (11 patients, 79%), the occurrence of a symptomatic epidural hematoma was considered a no-fault medical accident that was not caused by the surgeon. The presence of a drain did not have any medicolegal impact in the cases reviewed. Conclusion: The key element in medicolegal decisions is the reaction time of the healthcare teams, in particular the time between the onset of symptoms and surgical revision. According to these expert reviews, the placement of a drain was not taken into consideration during the medicolegal assessment of a postoperative symptomatic epidural hematoma. Level of Evidence: II; retrospective prognostic study, investigation of patient characteristics and their impact on functional outcome.Show less >

Peer reviewed article :

Oui

Audience :

Internationale

Popular science :

Non

Administrative institution(s) :

Université de Lille
Inserm
CHU Lille

Collections :

• Protéomique, Réponse Inflammatoire, Spectrométrie de Masse (PRISM) - U1192

Submission date :

2023-12-13T04:49:04Z
2024-01-22T14:52:55Z