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Attending Aware of Post-op Sepsis Too Late

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Attending Aware of Post-op Sepsis Too Late

By Tom A. Augello, CRICO

Related to: Diagnosis, Documentation, Surgery


Specialty: General Surgery

Category: Surgery and Diagnosis

Defendant: Attending Surgeon

Plaintiff: Patient's Estate

Result: Settled in Mid-range


A 60-year-old female patient underwent laparoscopic surgery to remove cancerous polyps from her colon. The operation was complicated by several adhesions that were taken down, and a low anterior resection was done.

Two days post-op (Friday night), the patient began to complain of abdominal pain. By the next morning, her temperature was 100.9; her abdomen was distended, and she was tachycardic.

On Monday morning the patient’s respiratory rate was increasing and she was experiencing shortness of breath. The general surgery resident ordered a CT scan to rule out a pulmonary embolism. The scan showed a large amount of free air in the upper abdomen.

On Tuesday, six days post-op, the CRICO-insured attending surgeon made the first note in the patient’s record since the operation, indicating she had increasing tachycardia and shortness of breath with increased abdominal distention. The attending noted that an enterotomy or anastomotic leak were likely problems. The patient was returned to the OR and an enterotomy was found. Several days later, the patient died of uncontrolled sepsis.

Her estate sued the attending surgeon, alleging negligent delay in diagnosis, delay in (repeat) surgery, and improper management. The case was settled with mid-range payment.

Contributing to the decision to settle the case before trial:

  1. Limited communication between the attending and house staff over the weekend (as the patient’s condition deteriorated).

  2. A lack of documented attention to the worsening symptoms by the attending surgeon until six days post-op.

  3. A compelling argument that the attending was uniquely positioned to connect his understanding of the surgical complications to the post-op symptoms and, thus, to diagnose enterotomy much earlier when the chances of controlling infection were significantly greater.


September 1, 2009
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