Determining Liability in Carotid Endarterectomy Malpractice Litigation

Objectives: Malpractice litigation and associated costs are a factor in increasing healthcare expenditures over recent decades. Serious potential complications accompanying carotid endarterectomy (CEA), along with the presence of accepted and widely-used alternatives, make this procedure a target for litigation. The objective of this analysis was to characterize the medicolegal environment regarding CEA, including factors determining legal responsibility. Methods: The WestLaw database was searched for medical malpractice related to CEA. Case outcomes, alleged cause(s) of malpractice, awarded damages, and other factors in litigation were recorded. Results: Of 37 jury verdicts and settlements in this analysis, defendants were found not liable in 25 (67.5%) cases. The most frequently reported complications were cerebrovascular accident (CVA) (51.3%) and hypoglossal nerve injury (27.0%), with other complications including airway compromise, vocal cord injury, and death. None of the cases reported myocardial infarction. Cerebral monitoring was mentioned in only two cases, while alleged inadequate informed consent, delay in diagnosis, and requirement of additional surgery were present in a considerable proportion. Settlements and jury awards averaged $895,833 and $1.53M respectively. Conclusions: CVA and hypoglossal nerve injury are the most frequently litigated complications of CEA. While the majority of decisions found physicians not liable, damages that were awarded were considerable, exceeding $1.5M, suggesting that characterization of factors in determining legal responsibility can help surgeons minimize liability as well as improve patient safety. The importance of explicitly listing these complications in informed consent may restrict liability, as may other steps such as perioperative cerebral monitoring in order to reduce injuries from a delay in CVA diagnosis.