Management of symptomatic postoperative epidural hematoma in spine surgery: Medicolegal implications - 29/10/21
, Thibault Portella b, Thomas Amouyel c, Renaud Bougeard d, Richard Assaker a, Klaus-Luc Mourier b
Bienvenue sur EM-consulte, la référence des professionnels de santé.
Article gratuit.
Connectez-vous pour en bénéficier!
Abstract |
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 of this 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 revision of 11 days). In 2 cases, the liability of a nurse working in the 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.
Le texte complet de cet article est disponible en PDF.Keywords : Epidural hematoma, Spine surgery, Neurologic deficit, Complications, Expert review, Medicolegal
Plan
Vol 107 - N° 7
Article 103024- novembre 2021 Retour au numéro
Article précédent
- Evaluation of enhanced recovery after spine surgery: Specificities in an academic public hospital
- Adrien Lampilas, Benjamin Bouyer, Emmanuelle Ferrero, Marc Khalifé, Angélique Bergeot, Pierre Guigui, Guillaume Lonjon
- Diagnosis of reoperated cervical non-union: Multicenter retrospective study about 45 patients
- Maxime Huneidi, Yves Ntilikina, Ibrahim Obeid, Benjamin Bouyer, Fahed Zairi, Paulo Marinho, Yann-Philippe Charles, Jean-Marc Vital, Olivier Gille, Louis Boissière
Bienvenue sur EM-consulte, la référence des professionnels de santé.