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Litigation in Rhinoplasty

Ganesh Kumar, Nishant M.D.; Hricz, Nicholas B.S.; Drolet, Brian C. M.D.

Author Information
Plastic and Reconstructive Surgery: February 2019 - Volume 143 - Issue 2 - p 456e-458e
doi: 10.1097/PRS.0000000000005249
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Sir:

Rhinoplasty remains one of the most common operations performed in the United States—approximately 220,000 were performed in 2017.1 Performed by appropriately trained surgeons, rhinoplasty results in good outcomes with high patient satisfaction.2–4 Although serious complications such as hematoma, infection, perforation, and breathing difficulties are relatively rare, the consequences can be devastating.5 When complications occur, some patients pursue malpractice litigation based on a breach in the standard of care. This study aimed to identify the factors associated with malpractice litigation against surgeons performing rhinoplasty.

Westlaw (Thomson Reuters, Eagan, Minn.) is a legal research service containing more than 40,000 cases in an online database.6 Using the keywords “medical,” “malpractice,” and “rhinoplasty,” the database was reviewed for all rhinoplasty malpractice cases resulting in jury verdicts and settlements. All reports were reviewed by the authors to determine plaintiff and defendant demographics, alleged liability, and legal outcomes. Training information of named defendant surgeons was extracted manually through a broad Internet search.

A total of 40 unique cases directly related to injury after rhinoplasty were identified. The majority of plaintiffs were female [n = 37 (93 percent)], whereas the majority of defendants were male surgeons [n = 36 (90 percent)] (Table 1). Most surgeons were trained in plastic surgery (54 percent), followed by otolaryngology (27 percent) (Table 2). Only 14 percent of surgeons underwent a facial plastic surgery fellowship after residency. The majority of cases were in favor of the defendant (85 percent). Of the cases that resulted in monetary awards to the plaintiff, none were against fellowship-trained surgeons. Monetary awards ranged from $16,362 to $606,575 and were on average higher for non–fellowship-trained otolaryngologists (mean, $403,288) (Table 2). The most common alleged liability was surgeon negligence [n = 30 (75 percent)], with 17 percent of those cases resulting in a monetary award.

T1
Table 1.:
Demographics of Plaintiffs and Defendants along with Defendant Training
T2
Table 2.:
Cases Resulting in Jury Verdicts along with Monetary Compensations

This study demonstrates that most malpractice litigation following rhinoplasty is awarded in favor of the surgeon. To successfully litigate, a plaintiff must demonstrate that the defendant-surgeon had a duty to care for the patient and committed a breach in the standard of care, and that injuries and damages resulted from this breach. Factors associated with a verdict favoring the plaintiff included surgeon negligence resulting in definable damages. When litigation was successful, the monetary award to the plaintiff was often substantial. Whereas more rhinoplasties were performed by plastic surgeons in this cohort, the rate of successful litigation against both training groups (plastic surgeons and otolaryngologists) was equal. The majority of surgeons in this cohort did not have fellowship training. Among fellowship-trained surgeons, there were no successful cases of litigation by a plaintiff. This suggests that there may be some protective effect of dedicated training and additional experience in performing rhinoplasty. Overall, this viewpoint demonstrates the importance of surgeon training and experience in avoiding negligence and subsequent malpractice litigation.

DISCLOSURE

None of the authors has a financial interest to declare in relation to the content of this article.

Nishant Ganesh Kumar, M.D.
Section of Plastic Surgery
Department of Surgery
University of Michigan
Ann Arbor, Mich.

Nicholas Hricz, B.S.
University of Maryland, College Park
Baltimore, Md.

Brian C. Drolet, M.D.
Department of Plastic Surgery
Department of Biomedical Informatics
Vanderbilt University Medical Center
Nashville, Tenn.

REFERENCES

1. American Society of Plastic Surgeons. 2017 plastic surgery statistics report. Available at: https://www.plasticsurgery.org/documents/News/Statistics/2017/plastic-surgery-statistics-report-2017.pdf. Accessed June 3, 2018.
2. Tanna N, Nguyen KT, Ghavami A, et al. Evidence-based medicine: Current practices in rhinoplasty. Plast Reconstr Surg. 2018;141:137e–151e.
3. Simsek G, Demirtas E. Comparison of surgical outcomes and patient satisfaction after 2 different rhinoplasty techniques. J Craniofac Surg. 2014;25:1284–1286.
4. Schwitzer JA, Sher SR, Fan KL, Scott AM, Gamble L, Baker SB. Assessing patient-reported satisfaction with appearance and quality of life following rhinoplasty using the FACE-Q appraisal scales. Plast Reconstr Surg. 2015;135:830e–837e.
5. Layliev J, Gupta V, Kaoutzanis C, et al. Incidence and preoperative risk factors for major complications in aesthetic rhinoplasty: Analysis of 4978 patients. Aesthet Surg J. 2017;37:757–767.
6. Westlaw TR. Westlaw Jury Verdicts 2017. Available at: http://legalsolutions.thomsonreuters.com/law-products/westlaw-legal-research/jury-verdicts. Accessed June 3, 2018.

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