Risk Factors and Liability Distribution in Medical Disputes Related to Spinal Diseases: A Six-Year Retrospective Study in Beijing.

PURPOSE: To summarize the characteristics and liability distribution of medical disputes related to spinal diseases in Beijing and to identify factors associated with major harm and liability allocation. METHODS: We retrospectively analyzed 180 spine-related dispute cases obtained from the Beijing Medical Dispute Mediation Committee (January 2015-December 2020). We extracted information on outcomes, liability allocation, and potential risk factors, and performed descriptive and regression analyses. RESULTS: The main adverse events leading to disputes were misdiagnosis/mistreatment (61 cases, 33.9%), surgical/operation errors (54 cases, 30.0%), infection (13 cases, 7.2%), new neurologic deficit (13 cases, 7.2%), and insufficient symptom relief (10 cases, 5.6%). Additionally, 29 cases (16.1%) were determined as disease/treatment itself. Physicians were primarily liable in 116 cases (64.4%), and major patient harm occurred in 33 cases (18.3%). Major harm was associated with misdiagnosis/mistreatment (univariate analysis, P=0.006; multivariate analysis, OR= 3.281, 95% CI 1.359-7.918, P=0.008), emergency (univariate analysis, P=0.020; multivariate analysis, OR=13.446, 95% CI 1.042-173.422, P=0.046), and treatment during holidays (univariate analysis, P=0.035; multivariate analysis, OR=4.125, 95% CI 1.182-14.399, P=0.026). Liability distribution for misdiagnosis/mistreatment was unfavorable to the doctors (univariate analysis, P=0.028; multivariate analysis, OR=2.144, 95% CI 1.071-4.291, P=0.031). Overall, 116 cases (64.4%) were resolved through mediation, with an actual average compensation amount of 220,272.72 RMB (range 5,000-2,381,523 RMB). CONCLUSION: This study characterizes the clinical features, liability distribution, and factors associated with major harm in spine-related medical disputes handled through formal mediation in Beijing. The findings provide region-specific evidence that may support targeted quality improvement, clinical risk management, and dispute-prevention strategies in spine care.