Characteristics and outcomes of venous thromboembolism-related litigation in orthopaedic surgery

BACKGROUND: Venous thromboembolism (VTE) is a considerable source of morbidity, mortality, and economic burden within orthopaedic surgery. Our study aimed to analyze the characteristics and reasons for lawsuits pertaining to VTE levied against orthopaedic surgeons. METHODS: The Westlaw database was queried for cases filed between 1980 and 2023 against orthopaedic surgeons involving VTE, using the search terms "orthopaedic", "blood clot," "deep vein thrombosis," "venous thromboembolism," and "pulmonary embolism." RESULTS: A total of 122 out of 371 cases were selected for inclusion in this study. A defendant verdict was reached in 84 (69 %) cases and a plaintiff-verdict in 23 (19 %) cases. Fifteen (12 %) cases were settled. The mean indemnity payment and settlement award were $2.39 million and $662 thousand, respectively. Discontinuation or failure to initiate post-discharge anticoagulation therapy was cited in 25 % of cases. The most common basis of litigation was diagnostic/therapeutic delay (42 %) and inadequate VTE prophylaxis (39 %). Death was the most frequently reported complication (64 %). Patient-reported pain and suffering was associated with a defendant verdict (p = 0.0204). The choice of anticoagulant was not found to increase the risk of a plaintiff-favorable verdict (p = 0.6754). CONCLUSIONS: Malpractice cases related to VTE in orthopaedic surgery are associated with substantial financial liability and arise in the setting of delayed diagnosis of VTE or failure to initiate thromboprophylaxis. Current medicolegal trends do not indicate a preference for any specific VTE prophylactic agent. Implementing a systems-based strategy to optimize transitions of care may help reduce both the incidence of VTE and the associated risk of litigation.