• Anna Baukje Lebouille-Veldman, Tavneet Singh, Yug Patel, Philipp Lassarén, Noah Nawabi, Frederick Frankhauser, Marco Mammi, Ayaz Khawaja, Rania A Mekary, Jacob R Lepard, and Timothy R Smith.
• Department of Neurosurgery, Computational Neuroscience Outcomes Center, Brigham and Women's Hospital, Boston, Massachusetts, USA; Department of Neurosurgery, Leiden University Medical Center, Leiden, the Netherlands.
• World Neurosurg. 2023 May 1; 173: 218225.e4218-225.e4.

BackgroundNeurosurgeons, especially spine surgeons, have the highest risk of facing a malpractice claim. Average verdicts in spine surgery litigation has been shown to be over USD $1 million/case. This systematic review aimed to clarify the impact of tort reforms on neurosurgical health care environments across the United States, including patient outcomes, practice of defensive medicine, and physician supply aims.MethodsA systematic literature search was performed using PubMed, Embase, Cochrane, and Web of Science databases until May 13, 2022. Study quality was assessed using the quality assessment tool for studies reporting prevalence data.ResultsFive studies (all rated as good quality) were included. Two studies found that in higher-risk state malpractice environments, risk of postoperative complications was higher and odds of nonhome discharge were larger (odds ratio 1.1169, 95% confidence interval 1.139-1.200). One study found that neurosurgeons reported practice of defensive medicine by ordering more imaging in a higher-risk environment, while this was not shown in a study examining imaging rates in different medicolegal environments. One study observed that noneconomic damage caps were associated with a 3.9% increase of physician supply in high-risk specialties.ConclusionsThere was a suggestive association between tort reforms and less practice of defensive medicine among neurosurgeons, improvement in postoperative outcomes in spinal fusion patients, and increase in physician supply. More elaborate studies on the medicolegal environment in neurosurgical practice are needed to give more insight on the current size of the problem that litigation presents in the United States and the effects tort reforms have on neurosurgical health care environments.Copyright © 2023 Elsevier Inc. All rights reserved.

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