Determination of legal responsibility in iatrogenic tracheal and laryngeal stenosis.

OBJECTIVES/HYPOTHESIS Laryngotracheal stenosis usually occurs as a result of injury from endotracheal intubation or tracheostomy placement. With an estimated incidence of 1% to 22% after these procedures, chronic sequelae ranging from discomfort to devastating effects on quality of life, and even death, make this complication a potential litigation target. We examined federal and state court records for malpractice regarding laryngotracheal stenosis and examined characteristics influencing determination of liability. STUDY DESIGN Retrospective analysis. METHODS The Westlaw Next legal database (Thomson Reuters, New York, NY) was searched for pertinent federal and state malpractice cases and examined for several factors including alleged cause of malpractice, complications, case outcome, and specialty of the defendants. RESULTS Twenty-three pertinent cases over 35 years were identified. Fourteen (60.9%) cases were decided in the physician's favor, with six plaintiff verdicts awarding an average of $922,129 for malpractice, and three out-of-court settlements averaging $441,600. Hospitals were the most frequently named defendants, and anesthesiologists were most commonly named physician defendants. Endotracheal intubations and tracheostomy history were frequent factors in these cases. Laryngeal lesions were more likely to result in payments, trending higher than those stemming from tracheal lesions. CONCLUSIONS Multiple cases mentioned previous intubation as a potential risk factor that may have led to laryngotracheal stenosis. Location of stenosis and requirement of reparative procedures may also influence outcomes. Cases not decided in the defendant's favor frequently included other extenuating circumstances, including severity of other injuries. Although the majority of cases were defendant decisions, the verdicts decided for the plaintiffs had considerable damages awarded.