BACKGROUND:Medical malpractice contributes to an estimated $55.6 billion in overall medical liability system costs per year. The rise of medspas has resulted in an increase in complications and litigation. In this study, we identified all publicly indexed litigation against medical spas and medical spa practitioners using the Westlaw legal database and characterized trends in these findings. METHODS:A retrospective analysis of litigation against medical spas and medical providers performing care at medical spas was performed. Cases were indexed from 2006 to 2024 using the Westlaw legal database. Case documents were reviewed for the following datapoints: Patient characteristics (age, sex), legal case characteristics (state in which litigation occurred, reason for litigation, outcome, monetary payments, expert witness involvement), and medical procedure characteristics (type of procedure, location on the body in which the procedure was performed, complication, credentials of person who performed the procedure). RESULTS:Twenty legal cases met inclusion criteria, ranging in date from May 2006 to October 2024. The average patient age was 36 years old (SD 12.570). All plaintiffs were listed as female (n=20). 4 cases sued only the medspas, 15 sued only a medical practitioner, and in one case both the practitioner and medspa were sued. Each of the 20 cases were decided by jury decision at trial. 7 cases were won by the defendants (35%), whereas the remaining 13 cases were won by the plaintiffs. The average jury award was $2,489,128.69. CONCLUSIONS:Our findings highlight the importance of properly managing patient expectations and thorough discourse regarding the risks of the procedure to better align patient presurgery expectations with the final result. Our findings also emphasize the positive impact that tighter regulation of medical spas will have on patient safety. Our data is limited by the small sample size that was indexed on Westlaw legal database and descriptive in nature, so future studies analyzing larger cohorts of data may provide additional data to further benefit patient safety.
Access to total joint arthroplasty (TJA) remains profoundly limited in low- and middle-income countries despite the growing global burden of end-stage degenerative joint disease. Although international orthopaedic outreach initiatives have expanded surgical access, adult reconstructive surgery has traditionally been underrepresented because of implant dependency, infrastructure requirements, and logistical complexity. This review describes a systems-based framework for delivering high-volume total hip and knee arthroplasty in a resource-limited environment through long-term international collaboration. Drawing on experience from the Gift of Disability Alleviation (GODA) in partnership with the Indus Hospital and Health Network in Pakistan, the model emphasizes year-round operational planning, preoperative imaging and templating, implant forecasting, international shipping coordination, operating room efficiency, multidisciplinary perioperative pathways, and integrated education. Annual surgical missions routinely deliver over 250 primary total joint arthroplasties within a six-day operative period using a limited number of surgeons. By prioritizing reproducible infrastructure over episodic intervention, this framework illustrates a structured framework for delivery of high-volume arthroplasty in underserved settings.
Introduction Female firearm injury is rising yet remains understudied, particularly among survivors. We examined factors associated with mortality and the circumstances surrounding firearm injury in women. Methods We performed a retrospective multicenter mixed-methods study of 208 women with firearm injuries from five trauma centers (2012-2016), using regression and qualitative thematic analysis. Results Crude mortality was 14.4%; most patients were Black (70%) and injured by assault (72%). White women had higher unadjusted mortality than Black women (25.5% vs 9.9%; p = 0.008). In Firth-penalized multivariable analysis addressing complete separation, no variable independently predicted mortality; self-harm showed the strongest association but did not reach significance (OR 3.08, 95% CI 0.91-10.39; p = 0.07). Self-harm was far more common among white than Black women (31% vs 1%; p < 0.001) and predicted longer hospitalization. Qualitative themes included intimate partner violence, neighborhood violence, and self-harm. Conclusions Self-harm was race-patterned and associated with morbidity and mortality, though no factor independently predicted mortality after adjustment. Prospective multicenter study with injury-severity data is needed.
