Introduction
Medical malpractice refers to treatments that do not meet accepted medical standards and result in harm, disability, or death. Furthermore, malpractice is a relative concept, and knowledge levels vary among doctors. In addition to causing public health concerns, malpractice affects physicians’ personal and professional lives. When a doctor fails in diagnosis, treatment, or follow-up, resulting in patient harm, s/he has committed medical malpractice. However, not all treatment failures are due to malpractice, as medicine involves uncertainty, and even skilled doctors may experience unsuccessful outcomes. One major consequence is the formation of defensive medicine, where doctors, fearing lawsuits, order unnecessary tests or avoid high-risk treatments, which can compromise care quality and trust in the doctor-patient relationship. Although medical malpractice cases represent a small part of adverse healthcare system outcomes, they remain a valuable indicator of healthcare system quality. 
Despite medical advancements, medical malpractice claims are increasing globally, including in Iran, leading to decreased public trust and increased stress among both patients and physicians. These claims also impose emotional and financial burdens on the affected people. Given the cultural and systemic differences in how medical malpractice is handled, local studies—especially in high-risk fields such as general surgery—are crucial for identifying causes, improving safety, and restoring public confidence. The present study aims to investigate the frequency of medical malpractice in the field of general surgery and the associated factors in Guilan Province, north of Iran, from 2011 to 2017.

Methods
This descriptive retrospective study reviewed medical malpractice complaints in general surgery sent to the Legal Medicine Organization of Guilan Province from 2011 to 2017. After obtaining ethical approval and necessary permissions, the cases were analyzed, and the data, including patients’ demographic information, type of treatment, surgical details, cause of malpractice, and the verdict of the Medical Commission, were extracted using a checklist. Data were entered into SPSS software, version 21 and analyzed using descriptive statistics, the chi-square test, and Fisher’s exact test, considering a significance level set at 0.05. 

Results
This study examined 84 medical malpractice complaint cases related to general surgery. Of these cases, 48 were related to male patients and 36 to female patients. As shown in Table 1, in 43 cases (51.19%), the verdict was rendered against the physician, while in 41 cases (48.81%), the physician was acquitted. Notably, none of the cases ended due to patient satisfaction or reconciliation between the parties. Regarding the type of medical center, 41 patients (48.81%) had general surgery at public teaching centers, 6 (7.14%) at public non-teaching centers, and 37 (44.05%) at private centers. In 57 cases, the complaints were related to elective treatments, while 27 cases (32.14%) were related to emergency treatments. The abdomen was the most commonly affected organ by malpractice (n=46, 54.76%), followed by the upper limbs (n=18, 21.43%).



We found no statistically significant difference in the malpractice rate between male (47.92%) and female (55.56%) patients (P= 0.097). Similarly, no significant differences were found based on patients’ age (P=0.097), gender (P=0.488), or marital status (P=0.355). The malpractice rate was not significantly different based on the type of medical center, the injured site, or the nature of harm caused by malpractice, either.
Although malpractice rates were higher in elective treatments compared to emergency treatments, as well as in cosmetic surgeries compared to therapeutic surgeries, these differences were not statistically significant (P>0.05). Surgical complications were more common than amputations or deaths (as outcomes of malpractice), but the difference was not statistically significant.
The physicians who were not general surgeons and those with board certification had higher malpractice rates compared to board-certified general surgeons. However, this difference was also not statistically significant.

Conclusion
In about 51% of complaints in Guilan Province regarding general surgery malpractice, the verdict was rendered against the physicians. The current study found 16.67% of malpractice cases were due to negligence and 28.57% due to a combination of factors such as lack of skills, carelessness, negligence, and failure to comply with government regulations. There is a need for more comprehensive studies to explore potential risk factors and improve patient safety in surgical practices.

Ethical Considerations

Compliance with ethical guidelines
This study was approved by the Ethics Committee of Guilan University of Medical Sciences, Rasht, Iran (Code: IR.GUMS.REC.1398.300). To maintain confidentiality, the review of cases was done onsite, and complainants’ personal information was not recorded.

Funding
This research did not receive any financial support from funding organizations in the public, commercial, or non-profit sectors.

Authors contributions
Conceptualization: Alireza Badsar, Mahan Azizzade Dobakhshari; data collection: Alireza Badsar, Mahan Azizzade Dobakhshari, Pirooz Samidoust, and Kiavash Razaghi; validation: Alireza Badsar, Pirooz Samidoust, and Erfan Badsar; data analysis and investigation: Mahan Azizzade Dobakhshari, Pirooz Samidoust, and Erfan Badsar; resources: Kiavash Razaghi, Alireza Badsar, and Erfan Badsar; initial draft preparation: Mahan Azizzade Dobakhshari, Kiavash Razaghi, and Alireza Badsar; editing & review: Mahan Azizzade Dobakhshari, Pirooz Samidoust, and Alireza Badsar; supervision, project management; validation: Mahan Azizzade Dobakhshari and Erfan Badsar.

Conflicts of interest
The authors declare no conflicts of interest.

Acknowledgments
The authors would like to thank the Department of Forensic Medicine at Guilan University of Medical Sciences, and Mr. Mehdi Ghorbani Samim (the former head of the Guilan Legal Medicine Organization) for their support and assistance in this research.




 

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