Risk Factors & Consent: Open-Heart Surgery Causes Patient Disability

A male patient received a stent placement after chest pain presentation while traveling as a truck driver.

He consulted with a local cardiothoracic surgeon when returning home and underwent successful, complex open-heart surgery involving vein harvesting and a vein graft.

However, a foot drop injury related to the damage of the peroneal nerve presented when the patient returned to consciousness postoperatively. As a result, a lingering and permanent limp affects the patient's gait which prevents returning to his occupation and is now considered a disability.

The plaintiff determined the injury as idiopathic and convinced that the damage should not have occurred during the surgery.

Additionally, his theory included that either a table or equipment positioning error or direct nerve compression created the muscle weakness or paralysis characteristic of foot drop.

Rare Complications: Nerve injury

The defendants denied the patient's theory for injury and justified it as a rare complication while insisting that the surgical team did not accidentally cause the nerve injury.

The patient was in contact with numerous medical professionals before undergoing extensive open-heart bypass surgery to prevent future ischemic attacks.

Neither the patient's medical history, prior complaints, or apparent reports of staff suggested that the patient presented with a limp or symptoms characteristic of foot drop on or before the day of surgery.

Additionally, no witnesses or the surgical team admitted to a possible injury to the patient's peroneal nerve within the fully staffed operating room.

Risk Factors & Consent:

The patient must understand and consent to the possible side effects and risk factors before medical professionals perform any surgery or procedure.

Although foot drop is classified as a rare complication when associated with open-heart surgery, it is unknown if the patient understood and consented to less likely or rare complications.

Unless the facility standardizes what possible complications to include when discussing the surgical procedure and gaining consent, the physician may not have disclosed every possible surgical complication.

It is also unknown if the patient would have provided consent with understanding the potential for nerve damage, permanent injury, or occupational disability. However, the patient should have received a general statement acknowledging possible disability or death as a result of any surgery.

Negligence or No?

With the lack of reasoning for the injury, the patient attempted to infer negligence of the damage without evidence, according to the res ipsa loquitur theory.

Although the patient has not exhibited foot drop or nerve damage symptoms before the surgery and understanding the likelihood of developing foot drop, determining the cause is difficult without direct evidence, when the reason may be idiopathic.

Nonetheless, the development of new symptoms is very frustrating for the patient; the premise of medicine is that the benefits must outweigh the risks.

The patient's surgery was essential to improve circulation and prevent another potentially fatal ischemic event, thus considered a life-saving priority over the resulting foot drop symptoms.