15 Strategies for Tackling Surgical Treatment Risks in Gynecology

Laura M. Cascella, MA, CPHRM

Analysis of MedPro claims data reveals that allegations related to surgical treatment represent the highest malpractice case volume for gynecology providers. These allegations also account for more than half of all dollars paid for expense and indemnity costs associated with gynecology claims.¹

Within these surgical treatment allegations, the top issue cited is improper performance of surgery. This allegation accounts for 57 percent of surgical treatment cases — more than half of which involve hysterectomies. Other procedures noted in these allegations include oophorectomy, endometrial ablation, lysis of peritoneal adhesions, and incontinence-related procedures.

Improper management of surgical patients accounts for 33 percent of surgical treatment cases and involves various suboptimal situations during the perioperative period, such as inadequate monitoring of vital signs, improper surgical skin site preparation, and delayed recognition of complications following discharge.

A small percentage of surgical treatment allegations (5 percent) involve retained foreign bodies. Although the case volume is low, these allegations are still concerning because retained foreign bodies are considered a "never event."

To improve patient safety during the perioperative period and reduce liability exposure, gynecology providers can implement various strategies to manage the risks inherent in surgical treatment. For example:

1. Adhere to well-defined credentialing, recredentialing, and privileging policies, including evaluation of surgical skills and competency with surgical equipment through ongoing practice performance evaluation and focused professional practice evaluation.
2. Implement peer review processes and conduct peer review activities to improve performance and quality. Providers should routinely evaluate quality indicators and implement performance improvement plans to address safety risks and improve quality of care.
3. Engage in ongoing continuing medical education and training opportunities to enhance technical surgical skills and improve teamwork.
4. Conduct thorough informed consent discussions with patients, including a review of risks, benefits, and alternative treatments. During these conversations, speak in layman's terms and use a technique such as teach-back to gauge patients' comprehension of information.
5. Document informed consent discussions, including the provision of verbal and written patient education; make sure any signed informed consent forms are included in patients' records.
6. Verify that each patient's record contains thorough and appropriate information, such as history and physical, current medications, nonpharmacological interventions, allergies, pain assessment outcomes, test results, consults/referrals, treatment goals, and preoperative screening results.
7. Conduct a thorough preoperative screening of each patient for risk factors, and ensure that all appropriate health information for the patient is available prior to starting the procedure.
8. Verify that all necessary equipment and supplies are available before each procedure begins.
9. Ensure infection prevention and control best practices are used to maintain the sterile field (e.g., best practices related to hand hygiene, safe injections, skin preparation, instrument sterilization, environmental cleaning, etc.).
10. Use standardized patient safety precautions during each procedure, such as timeout protocols, proper patient positioning, surgical item counts, etc.
11. Make sure patients are appropriately monitored during procedures, and maintain consistent postoperative patient assessment and monitoring processes, including diligence in checking patients' vital signs, airway, mental/cognitive status, pain, hydration, wound healing, etc.
12. Maintain a consistent postoperative discharge assessment process, and carefully consider repeated patient complaints or concerns when making clinical decisions about patient care following surgical treatment.
13. Provide patients and caregivers with clear and concise written and verbal instructions related to their treatment plans and follow-up care.
14. Complete a detailed operative report on the day of each procedure.
15. Document all instances of patient nonadherence as they occur using objective information, and document any follow-up outreach or education provided to the patient or caregiver to address nonadherence.

To learn more about trends in gynecology malpractice cases, see MedPro's Claims Data Snapshot: Gynecology.

Endnote

¹ MedPro Group. (2025). Claims data snapshot: Gynecology. Retrieved from https://resource.medpro.com/documents/10502/5086243/Gynecology.pdf

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