Medical Malpractice in Neurosurgery: An Analysis of Claims in the Netherlands

Wouter J Dronkers; Dennis R Buis; Quirine J M A Amelink; Gert-Joan Bouma; Wilco C Peul; W Peter Vandertop; Marike L D Broekman; Aart C Hendriks; Clemens M F Dirven; Jochem K H Spoor

doi:10.1227/neu.0000000000003117

Medical Malpractice in Neurosurgery: An Analysis of Claims in the Netherlands

Neurosurgery. 2024 Jul 26. doi: 10.1227/neu.0000000000003117. Online ahead of print.

Authors

Wouter J Dronkers¹, Dennis R Buis^{2

3}, Quirine J M A Amelink^{4

5}, Gert-Joan Bouma^{2

3}, Wilco C Peul^{6

7}, W Peter Vandertop^{2

3}, Marike L D Broekman^{6

7}, Aart C Hendriks⁸, Clemens M F Dirven¹, Jochem K H Spoor¹

Affiliations

¹ Department of Neurosurgery, Erasmus University Medical Centre Rotterdam, Rotterdam, The Netherlands.
² Department of Neurosurgery, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
³ Amsterdam Neuroscience Centre, Neurovascular Disease, Amsterdam, The Netherlands.
⁴ Department of Legal Affairs, The Dutch Health and Youth Care Inspectorate, Utrecht, The Netherlands.
⁵ Erasmus University Rotterdam, Erasmus School of Health Policy and Management, Rotterdam, The Netherlands.
⁶ Department of Neurosurgery, Leiden University Medical Center, Leiden, The Netherlands.
⁷ Department of Neurosurgery, Haaglanden Medical Center, The Hague, The Netherlands.
⁸ Faculty of Law, Leiden University School of Law, Leiden, The Netherlands.

PMID: 39058041
DOI: 10.1227/neu.0000000000003117

Abstract

Background and objectives: Studying malpractice claims is important to improve quality of health care and patient safety and to educate the individual healthcare providers. The objective of this study was to describe characteristics of neurosurgical claims in the Netherlands.

Methods: A nationwide retrospective observational study of neurosurgery-related claims closed by Centramed and MediRisk, 2 major insurance companies in the Netherlands, was performed. Relevant data, including type of neurosurgical pathology, theme and category of the claim, type and severity of injury, outcome, and financial burden, were extracted from anonymized claim files. The estimated annual risk was used to determine the risk for claims by adjusting for the number of annually practicing neurosurgeons in the Netherlands.

Results: A total of 388 claims against neurosurgeons were closed between 2007 and 2021. Liability was denied in a slight majority of claims (n = 230; 59%). The total burden during this period was €6 165 000 (amount paid out to patients: €5 497 000). The estimated annual risk per Dutch neurosurgeon for a claim was 15.5%, meaning 1 claim per 6.5 years. The case-level analysis of 238 available anonymized claims revealed that most claims were related to spinal pathology (81.5%), followed by cranial pathology (10.9%) and peripheral nerve (7.6%). The motivations for filing claims were mostly related to alleged surgical (56.3%) or diagnostic errors (22.3%). Most of these claims were denied (151/238; 63.4%), and fewer were settled (42/238; 17.6%), sustained (31/238; 13.0%), or closed without final decision (14/238; 5.9%).

Conclusion: Neurosurgery-related malpractice claims primarily involved spinal pathology and were mostly related to alleged treatment errors. Most claims did not result in compensation because there seemed to be no liability or culpable injury. However, the annual risk for a claim for Dutch neurosurgeons is considerable.