Status of thyroid surgery-related medical disputes in China.

Abstract

Background: Thyroid diseases, particularly thyroid cancer, are becoming increasingly prevalent, with surgery remaining one of the primary treatments. However, thyroidectomy may result in complications and medical disputes, but very little research has examined this subject in the Chinese context. The study aims to conduct a retrospective analysis of thyroid surgery-related medical disputes in China, offering insights into conflict resolution and risk avoidance in both legal and medical contexts.

Methods: This retrospective study analyzed thyroid surgery-related medical dispute cases that occurred from 2010 to 2022 via the China Judgments Online website (https://wenshu.court.gov.cn). Before being included in the analysis, each case in the database was examined and carefully read to ensure that it was a dispute event caused by complications from thyroid surgery. Data collected included patient demographics, disease and surgical details, and judicial outcomes. Statistical analysis was performed using GraphPad Prism 9 (GraphPad Software).

Results: We identified 198 thyroid surgery disputes, with 74.2% of the patients being female and 58.6% being under 60 years old. Benign disease diagnoses accounted for 52.0% of cases, and traditional open surgery was predominant, occurring in 95.5% of the cases. An increased likelihood of complications and disputes was observed with more extensive surgeries. Tertiary hospitals were the defendants in 84.8% of these cases. The peak period of disputes was from 2011 to 2015, accounting for 51.0% of the total, with a notable concentration of cases in eastern China, accounting for 39.9%. The main causes of disputes were nerve damage (29.8%), parathyroid impairment (29.8%), and disagreements in resection scope (11.5%). Cases of hemorrhage led to the highest mean compensation amount [average Chinese Yuan (CNY) ¥680,000], followed by lymph fistula (CNY ¥524,000) and tracheoesophageal injury (CNY ¥466,000). In 66.7% of cases, the defendants were deemed equally or more responsible than plaintiffs. The average expected compensation was CNY ¥577,000, with the actual compensation being CNY ¥248,000, or 43.0% of the expected amount. Judgments were issued on average of 3.8 years after surgery, and only 10.6% were resolved within the same year and 21.2% after over 5 years, with the longest dispute lasting 45 years.

Conclusions: Medical disputes related to thyroid surgery primarily arise from nerve and parathyroid damage, with significant discrepancies between the expected and awarded compensation amounts. Lengthy resolution times highlight the need for enhanced communication related to surgical risk and a more efficient medical dispute resolution process.