Patterns and Outcomes of Physician-Related Complaints in Pediatric General Surgery

Abstract

Background: Patient complaints against physicians are a major concern in the Iranian medical community. Objectives: This study aimed to examine the patterns and outcomes of physician-related complaints in pediatric general surgery. Methods: This retrospective study reviewed all official complaint files related to physicians’ performance involving patients younger than 18 years who underwent surgery under general anesthesia at Imam Khomeini Hospital in Ilam, Iran, between 2022 and 2025. The unit of analysis was the official complaint file; multiple complaints related to a single file were considered a single complaint. Of 578 files initially reviewed, 175 met the inclusion criteria. Data were collected using a demographic information form and a researcher-made checklist. Content validity was confirmed by 10 faculty experts, and inter-rater reliability was established through independent review of 20 files, with Cohen’s kappa > 0.80 for qualitative variables and an intraclass correlation coefficient (ICC) > 0.85 for quantitative variables. Data were analyzed using descriptive statistics in SPSS version 18. Results: The mean age of the patients was 13.2 ± 3.8 years, and 54.3% were girls. Most admissions were elective (72.6%). Complaints were most commonly registered at the nursing office (37.1%), usually by the mother (72%), and primarily during hospitalization (76.6%). The most frequent complaint topics were inappropriate physician-family communication (17.7%), anesthesia-related complications (14.3%), and delays in physician visits (13.7%). Complaints most often involved residents/assistants (32.6%) and surgeons (30.9%). Most complaints were not directly related to general anesthesia (70.3%). Postoperative complications were reported in 46.3% of cases, with surgical site infection and severe or uncontrolled pain being the most common. Most patients achieved complete recovery (72%). Most complaints were closed without confirmation of medical negligence (92%), and only one case (0.6%) resulted in confirmed negligence. Most families were satisfied with the complaint-handling process (94.9%). Conclusions: Most complaints were registered during hospitalization, primarily by mothers, and were mainly related to communication problems and intraoperative care. Most patients achieved complete recovery, and most families were satisfied with the complaint resolution process.