Association Between State Medical Malpractice Environment and Postoperative Outcomes in the United States

Christina A. Minami, Catherine R. Sheils, Emily Pavey, Jeanette W. Chung, Jonah J. Stulberg, David D. Odell, Anthony D. Yang, David J. Bentrem, Karl Y. Bilimoria

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background The US medical malpractice system assumes that the threat of liability should deter negligence, but it is unclear whether malpractice environment affects health care quality. We sought to explore the association between state malpractice environment and postoperative complication rates. Study Design This observational study included Medicare fee-for-service beneficiaries undergoing one of the following operations in 2010: colorectal, lung, esophageal, or pancreatic resection, total knee arthroplasty, craniotomy, gastric bypass, abdominal aortic aneurysm repair, coronary artery bypass grafting, or cystectomy. The state-specific malpractice environment was measured by 2010 medical malpractice insurance premiums, state average award size, paid malpractice claims/100 physicians, and a composite malpractice measure. Outcomes of interest included 30-day readmission, mortality, and postoperative complications (eg sepsis, myocardial infarction [MI], pneumonia). Using Medicare administrative claims data, associations between malpractice environment and postoperative outcomes were estimated using hierarchical logistic regression models with hospital random-intercepts. Results Measures of malpractice environment did not have significant, consistent associations with postoperative outcomes. No individual tort reform law was consistently associated with improved postoperative outcomes. Higher-risk state malpractice environment, based on the composite measure, was associated with higher likelihood of sepsis (odds ratio [OR] 1.22; 95% CI 1.07 to 1.39), MI (OR 1.14; 95% CI 1.06 to 1.23), pneumonia (OR 1.09; 95% CI 1.03 to 1.16), acute renal failure (OR 1.15; 95% CI 1.08 to 1.22), deep vein thrombosis/pulmonary embolism (OR 1.22; 95% CI 1.13 to 1.32), and gastrointestinal bleed (OR 1.18; 95% CI 1.08 to 1.30). Conclusions Higher risk malpractice environments were not consistently associated with a lower likelihood of surgical postoperative complications, bringing into question the ability of malpractice lawsuits to promote health care quality.

Original languageEnglish (US)
Pages (from-to)310-318.e2
JournalJournal of the American College of Surgeons
Volume224
Issue number3
DOIs
StatePublished - Mar 1 2017
Externally publishedYes

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Malpractice
Odds Ratio
Quality of Health Care
Medicare
Sepsis
Pneumonia
Logistic Models
Myocardial Infarction
Fee-for-Service Plans
Legal Liability
Knee Replacement Arthroplasties
Gastric Bypass
Craniotomy
Cystectomy
Abdominal Aortic Aneurysm
Insurance
Pulmonary Embolism
Acute Kidney Injury
Coronary Artery Bypass
Venous Thrombosis

ASJC Scopus subject areas

  • Surgery

Cite this

Minami, C. A., Sheils, C. R., Pavey, E., Chung, J. W., Stulberg, J. J., Odell, D. D., ... Bilimoria, K. Y. (2017). Association Between State Medical Malpractice Environment and Postoperative Outcomes in the United States. Journal of the American College of Surgeons, 224(3), 310-318.e2. https://doi.org/10.1016/j.jamcollsurg.2016.12.012

Association Between State Medical Malpractice Environment and Postoperative Outcomes in the United States. / Minami, Christina A.; Sheils, Catherine R.; Pavey, Emily; Chung, Jeanette W.; Stulberg, Jonah J.; Odell, David D.; Yang, Anthony D.; Bentrem, David J.; Bilimoria, Karl Y.

In: Journal of the American College of Surgeons, Vol. 224, No. 3, 01.03.2017, p. 310-318.e2.

Research output: Contribution to journalArticle

Minami, CA, Sheils, CR, Pavey, E, Chung, JW, Stulberg, JJ, Odell, DD, Yang, AD, Bentrem, DJ & Bilimoria, KY 2017, 'Association Between State Medical Malpractice Environment and Postoperative Outcomes in the United States', Journal of the American College of Surgeons, vol. 224, no. 3, pp. 310-318.e2. https://doi.org/10.1016/j.jamcollsurg.2016.12.012
Minami, Christina A. ; Sheils, Catherine R. ; Pavey, Emily ; Chung, Jeanette W. ; Stulberg, Jonah J. ; Odell, David D. ; Yang, Anthony D. ; Bentrem, David J. ; Bilimoria, Karl Y. / Association Between State Medical Malpractice Environment and Postoperative Outcomes in the United States. In: Journal of the American College of Surgeons. 2017 ; Vol. 224, No. 3. pp. 310-318.e2.
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abstract = "Background The US medical malpractice system assumes that the threat of liability should deter negligence, but it is unclear whether malpractice environment affects health care quality. We sought to explore the association between state malpractice environment and postoperative complication rates. Study Design This observational study included Medicare fee-for-service beneficiaries undergoing one of the following operations in 2010: colorectal, lung, esophageal, or pancreatic resection, total knee arthroplasty, craniotomy, gastric bypass, abdominal aortic aneurysm repair, coronary artery bypass grafting, or cystectomy. The state-specific malpractice environment was measured by 2010 medical malpractice insurance premiums, state average award size, paid malpractice claims/100 physicians, and a composite malpractice measure. Outcomes of interest included 30-day readmission, mortality, and postoperative complications (eg sepsis, myocardial infarction [MI], pneumonia). Using Medicare administrative claims data, associations between malpractice environment and postoperative outcomes were estimated using hierarchical logistic regression models with hospital random-intercepts. Results Measures of malpractice environment did not have significant, consistent associations with postoperative outcomes. No individual tort reform law was consistently associated with improved postoperative outcomes. Higher-risk state malpractice environment, based on the composite measure, was associated with higher likelihood of sepsis (odds ratio [OR] 1.22; 95{\%} CI 1.07 to 1.39), MI (OR 1.14; 95{\%} CI 1.06 to 1.23), pneumonia (OR 1.09; 95{\%} CI 1.03 to 1.16), acute renal failure (OR 1.15; 95{\%} CI 1.08 to 1.22), deep vein thrombosis/pulmonary embolism (OR 1.22; 95{\%} CI 1.13 to 1.32), and gastrointestinal bleed (OR 1.18; 95{\%} CI 1.08 to 1.30). Conclusions Higher risk malpractice environments were not consistently associated with a lower likelihood of surgical postoperative complications, bringing into question the ability of malpractice lawsuits to promote health care quality.",
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