Litigation in Septorhinoplasty Surgery: A Pan-Specialty Review of National Health Service (the United Kingdom) Data

Abstract

Success in septorhinoplasty surgery can be difficult to assess due to a lack of objective and measurable outcomes. If patients' expectations are not met, it places surgeons performing septorhinoplasty at risk of litigation which can be stressful and costly. The National Institute of health (NHS) Resolution is a government-funded organization in the United Kingdom that provides expertise to the NHS on resolving patient concerns. Data were requested from NHS Resolution for claims involving septorhinoplasty surgery over a period of 5 years between April 2015 and April 2020. Rhinoplasty claims performed by all specialties were included. Data included the claim status, incident details, alleged injury, damages claimed, and damages paid. A total of 31 claims were identified by the study, equating to a total cost of £1,347,336.10. Of the 31 claims for rhinoplasty or septorhinoplasty, 9 cases were open (29%, £962,361.00) and 22 cases were closed (71%, £384,975.10). The common causes for claims were “intraoperative problems (32%),” “failure to warn–informed consent (19%),” and “foreign body left in situ (13%).” The most common injuries were “cosmetic disfigurement (39%),” “unnecessary pain (29%),” and “additional/ unnecessary operation (29%).” This study highlights the need for improved awareness of clinical negligence claims among surgeons who perform septorhinoplasty. Results are applicable to all specialties who perform the procedure. The study highlights the importance of assessing patients' motives and expectations prior to surgery and emphasizes the need for a well-documented rigorous consent process.

Keywords

rhinology - facial plastic surgery - rhinoplasty - septorhinoplasty - litigation

Publication History

Accepted Manuscript online:
26 July 2022

Article published online:
03 December 2022

• References

• 1 NHS Resolution. Behavioural insights into patient motivation to make a claim for clinical negligence. Accessed August 3, 2022, at: https://resolution.nhs.uk/wp-content/uploads/2018/10/Behavioural-insights-into-patient-motivation-to-make-a-claim-for-clinical-negligence.pdf
• 2 Kim J-Y, Cha M-J, Kwon S-S, Kim D-K. Factors that contribute to disagreement in satisfaction between surgeons and patients after corrective septorhinoplasty. Am J Rhinol Allergy 2017; 31 (06) 416-419
• 3 Thomson Reuters. Negligence. Accessed August 3, 2022, at: https://uk.practicallaw.thomsonreuters.com/0-107-6876?transitionType=Default&contextData=(sc.Default)&firstPage=true
• 4 Buckley PRA. Negligence—key elements to establish a negligence claim. Accessed August 3, 2022, at: https://www.lexisnexis.co.uk/legal/guidance/negligence-key-elements-to-establish-a-negligence-claim
• 5 Yau CWH, Leigh B, Liberati E, Punch D, Dixon-Woods M, Draycott T. Clinical negligence costs: taking action to safeguard NHS sustainability. BMJ 2020; 368: m552
• 6 Brennan TA, Sox CM, Burstin HR. Relation between negligent adverse events and the outcomes of medical-malpractice litigation. N Engl J Med 1996; 335 (26) 1963-1967
• 7 Resolution NHS, Resolution NHS. . Accessed August 3, 2022, at: https://resolution.nhs.uk/wp-content/uploads/2019/07/20190729-NHS-Resolution-Annual-report-and-accounts-2018-19-–costs-briefing.pdf
• 8 Resolution NHS. Annual report and accounts 2020/21. Accessed August 3, 2022, at: https://resolution.nhs.uk/wp-content/uploads/2021/07/Annual-report-and-accounts-2020-21-web.pdf
• 9 Svider PF, Keeley BR, Zumba O, Mauro AC, Setzen M, Eloy JA. From the operating room to the courtroom: a comprehensive characterization of litigation related to facial plastic surgery procedures. Laryngoscope 2013; 123 (08) 1849-1853
• 10 Unadkat SN, Pendolino AL, Auer D. et al. The evidence base for the benefits of functional septorhinoplasty and its future post COVID-19. Facial Plast Surg 2021; 37 (05) 625-631
• 11 NHS Digital. Hospital Episode Statistics (HES). Accessed March 2022, at: https://digital.nhs.uk/data-and-information/data-tools-and-services/data-services/hospital-episode-statistics
• 12 Ross EE, Anari S. Clinical commissioning group criteria for rhinoplasty and septorhinoplasty in England: survey of current guidance. J Laryngol Otol 2018; 132 (07) 591-595
• 13 Ceremsak J, Miller LE, Gomez ED. A Review of otolaryngology malpractice cases with associated court proceedings from 2010 to 2019. Laryngoscope 2021; 131 (04) E1081-E1085
• 14 Navaratnam AV, Pendolino AL, Kaura A. et al. Lessons from rhinology and facial plastics clinical negligence claims in England 2013-2018. J Laryngol Otol 2022; 136 (12) 1177-1182
• 15 Navaratnam AV, Hariri A, Ho C, Machin JT, Briggs TW, Marshall A. Otorhinolaryngology litigation in England: 727 clinical negligence cases against the National Health Service. Clin Otolaryngol 2021; 46 (01) 9-15
• 16 Heilbronn C, Cragun D, Wong BJF. Complications in rhinoplasty: a literature review and comparison with a survey of consent forms. Facial Plast Surg Aesthet Med 2020; 22 (01) 50-56
• 17 Durand M-A, Moulton B, Cockle E, Mann M, Elwyn G. Can shared decision-making reduce medical malpractice litigation? A systematic review. BMC Health Serv Res 2015; 15 (01) 167
• 18 Kelley BP, Koshy J, Hatef D, Hollier Jr LH, Stal S. Packing and postoperative rhinoplasty management: a survey report. Aesthet Surg J 2011; 31 (02) 184-189
• 19 NHS England patient Safety Domain. National Safety Standards for Invasive Procedures (NatSSIPs). Accessed August 3, 2022, at: https://www.england.nhs.uk/wp-content/uploads/2015/09/natssips-safety-standards.pdf
• 20 Andrews PJ, Choudhury N, Takhar A, Poirrier AL, Jacques T, Randhawa PS. The need for an objective measure in septorhinoplasty surgery: are we any closer to finding an answer?. Clin Otolaryngol 2015; 40 (06) 698-703
• 21 Li CH, Kaura A, Tan C, Whitcroft KL, Leung TS, Andrews P. Diagnosing nasal obstruction and its common causes using the nasal acoustic device: A pilot study. Laryngoscope Investig Otolaryngol 2020; 5 (05) 796-806
• 22 Menger DJ, Richard W, Swart KM, Grolman W. Does functional septorhinoplasty provide improvement of the nasal passage in validated patient-reported outcome measures?. ORL J Otorhinolaryngol Relat Spec 2015; 77 (03) 123-131
• 23 Klassen AF, Cano SJ, Schwitzer JA, Scott AM, Pusic AL. FACE-Q scales for health-related quality of life, early life impact, satisfaction with outcomes, and decision to have treatment: development and validation. Plast Reconstr Surg 2015; 135 (02) 375-386
• 24 Floyd EM, Ho S, Patel P, Rosenfeld RM, Gordin E. Systematic review and meta-analysis of studies evaluating functional rhinoplasty outcomes with the NOSE Score. Otolaryngol Head Neck Surg 2017; 156 (05) 809-815
• 25 Veer V, Jackson L, Kara N, Hawthorne M. Pre-operative considerations in aesthetic facial surgery. J Laryngol Otol 2014; 128 (01) 22-28
• 26 de Souza TSC, Patrial MTCRO, Meneguetti AFC, de Souza MSC, Meneguetti ME, Rossato VF. Body dysmorphic disorder in rhinoplasty candidates: prevalence and functional correlations. Aesthetic Plast Surg 2021; 45 (02) 641-648
• 27 Unadkat S, Pendolino AL, Joshi A. et al. A national survey of functional septorhinoplasty surgery performed in the United Kingdom: a clinician end-user questionnaire to assess current practice and help inform future practice. Eur Arch Otorhinolaryngol 2020; 277 (02) 475-482