Malpractice outcomes of perioperative ischaemic optic neuropathy after nonocular surgery

Abstract

Background

Perioperative vision loss following nonocular surgery is a rare but devastating complication. It typically occurs following spinal, cardiac, or head and neck procedures with ischaemic optic neuropathy being the primary cause. Despite increased understanding of potential risk factors, such as prolonged prone positioning, anaemia and hypotension, the legal implications remain underexplored. This study investigates malpractice litigation outcomes related to perioperative ischaemic optic neuropathy in the US.

Methods

We conducted a retrospective analysis of US malpractice cases involving perioperative ischaemic optic neuropathy following nonocular surgeries using the Westlaw Database. Cases included only those with jury verdicts and settlements. Relevant data, including patient demographics, surgery performed, defendant specialties, verdicts and monetary awards were collected and analysed.

Results

12 cases were included. Most affected patients were males (83.3%) with a mean age of 52 years. Spinal surgery (50%) was the most common procedure, and anaesthesiology (75%) was the most commonly litigated specialty. In 75% of cases, the defence was successful; however, in 16.7% of cases, the plaintiff won, with an average inflation-adjusted award of US$4.8 million (in 2024 dollars).

Conclusion

Malpractice claims related to perioperative ischaemic optic neuropathy predominantly favour defendants, suggesting that this complication is often viewed as unpreventable. However, proactive risk mitigation strategies, such as optimised positioning and thorough informed consent procedures, remain crucial to improving patient care and minimising litigation risks.