Analysis of causative factors and preventive strategies for traumatic orthopedic medical malpractice in Shanghai: a high-responsibility perspective

Background Medical malpractice is recognized as the most severe category of adverse medical events, characterized by illegality, negligent conduct, and resultant harm. Cases classified as high-responsibility-level malpractice impose substantial impacts on healthcare institutions and medical personnel. This study aims to identify negligence-related determinants contributing to such cases and to explore targeted preventive strategies designed to reduce the occurrence of high-responsibility-level medical malpractice. Methods A total of 125 cases of traumatic orthopedic medical malpractice were retrieved from the Office of Medical Malpractice Handling under the Shanghai Municipal Health Commission. Statistical analyses were conducted using SPSS 26.0. Descriptive data were presented as counts, frequencies, and percentages. Intergroup differences in negligence-related factors between high- and low-responsibility-level categories were evaluated using chi-square tests. Additionally, binary stepwise logistic regression analysis was performed to determine independent associations between specific negligence factors and high responsibility levels. Results Traumatic orthopedic medical malpractice cases in Shanghai demonstrated several distinct characteristics, including a relatively low mortality rate (4.00%), a notably high disability rate (74.4%), a greater occurrence in secondary hospitals (60.00%), and increased involvement of attending physicians and associate chief physicians (76.80%). High-responsibility-level cases constituted 45.60% of all included cases. Chi-square analysis indicated that inappropriate surgical procedures and violations of clinical practice standards were significantly more prevalent in the high-responsibility-level group compared with the low-responsibility-level group ( P < 0.05). Logistic regression analysis further revealed that inappropriate surgical procedures [odds ratio (OR) = 6.078], violations of clinical practice standards (OR=5.001), and missed or misdiagnoses (OR=2.872) were independently associated with elevated responsibility levels. Stratified regression analysis further indicated that violations of clinical practice standards represented the dominant negligence factor in secondary hospitals (OR=2.94), whereas inappropriate surgical procedures constituted the primary determinant in tertiary hospitals (OR=7.20). Conclusions Several preventive measures are recommended, including strengthening perioperative management, ensuring strict compliance with clinical diagnostic, therapeutic, and nursing protocols, standardizing imaging examinations and comprehensive physical assessments to reduce missed and misdiagnoses, enhancing physician–patient communication, standardizing medical record documentation, and reinforcing early postoperative rehabilitation strategies.