A 2014-2023 updated evaluation by the American Society of Metabolic and Bariatric Surgery of medical malpractice claims.

BACKGROUND: Metabolic and bariatric surgery (MBS) has achieved an excellent safety profile through robust quality standards. Closed claims analyses can identify vulnerabilities in MBS safety. OBJECTIVES: To analyze medical malpractice claims and identify opportunities for improvement. SETTING: University and private practice hospitals in the United States. METHODS: Using Candello, a national database of medical professional liability claims, We studied closed claims involving MBS cases from 2014-2023. Cases were professionally coded and analyzed for total incurred cost (TIC), major responsible injury and allegation, injury severity, procedure type, and top contributing factors. RESULTS: 195 MBS cases (370 defendants) were identified, with a TIC of $52,294,474 ($297,128/case). Sleeve gastrectomy accounted for 25.1% of cases. High-severity injury or death occurred in 43%. The most common major injury was puncture/perforation (n = 31, 16%). Improper management represented 84% of TIC, with the most frequent injuries being dehiscence (n = 9), hemorrhage (n = 9), obstruction (n = 9), and sepsis (n = 7). The top contributing factors were technical skill (76%), clinical judgment (68%), and communication (38%). Among technical skill, 57% involved a known surgical complication, 15% poor technique, 5% retained foreign body, 2% positioning, 2% inexperience, and 2% misidentification of anatomy. Among the 46 deaths, 76% had an allegation of improper management of the surgical patient, with inappropriate procedure selection/management the top contributing factor. CONCLUSIONS: Despite continued advancements in MBS, malpractice claim analysis highlights opportunities to improve technical skill, clinical judgment of managing complications, and communication among care teams.