Information about national trends and predictors of malpractice payments can constructively add to the hotly debated topic of medical malpractice. We sought to evaluate predictors of surgical malpractice payments and to explore national trends.

Retrospective analysis of surgery-related malpractice payments using the National Practitioner Data Bank from 1990 to 2006. Payments were adjusted to 2006 dollars. We evaluated predictors of payment size and large payments (defined as those >$1 million). Statutory law in the states demonstrating significant predictive values was analyzed.

In total, 58,518 surgical malpractice payments met inclusion criteria. Patients were predominantly female (62%) and inpatient (63%), with a mean age of 42 years. The number of payments decreased and payment sums increased during the study period. Median payment was $132,915 (95th percentile $983,263). Claims most frequently cited improper performance (42%). Patient outcomes were the strongest predictor of both payment size and likelihood of a large payment. Children younger than 10 years old were 70% more likely to receive a large payment (p = 0.005); and patients older than 70 years were 80% less likely (p < 0.0005). Large variations across states were seen for both payment size and likelihood of large payment. The likelihood of reaching out-of-court settlement did not appear to be correlated with known factors.

Nationwide, surgical malpractice claims show rising payment amounts. Patient outcomes are the strongest predictor of payment size. Considerable variation in payment size between states suggests a profound impact from local legal environments.