Document Detail


Injuries associated with regional anesthesia in the 1980s and 1990s: a closed claims analysis.
MedLine Citation:
PMID:  15220784     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The authors used the American Society of Anesthesiologists Closed Claims Project database to identify specific patterns of injury and legal liability associated with regional anesthesia. Because obstetrics represents a unique subset of patients, claims with neuraxial blockade were divided into obstetric and nonobstetric groups for comparison. METHODS: The American Society of Anesthesiologists Closed Claims Project is a structured evaluation of adverse anesthetic outcomes collected from closed anesthesia malpractice insurance claims of professional liability companies. An in-depth analysis of 1980-1999 regional anesthesia claims was performed with a subset comparison between obstetric and nonobstetric neuraxial anesthesia claims. RESULTS: Of the total 1,005 regional anesthesia claims, neuraxial blockade was used in 368 obstetric claims and 453 of 637 nonobstetric claims (71%). Damaging events in 51% of obstetric and 41% of nonobstetric neuraxial anesthesia claims were block related. Obstetrics had a higher proportion of neuraxial anesthesia claims with temporary and low-severity injuries (71%) compared with the nonobstetric group (38%; P <or=0.01) and a lower proportion of claims with death or brain damage and permanent nerve injury compared with the nonobstetric group (P <or= 0.01). Cardiac arrest associated with neuraxial block was the primary damaging event in 32% of obstetric and 38% of nonobstetric neuraxial anesthesia claims involving death or brain damage. Eye blocks accounted for 5% of regional anesthesia claims. CONCLUSION: Obstetric claims were predominately associated with minor injuries. Permanent injury from eye blocks increased in the 1990s. Neuraxial cardiac arrest and neuraxial hematomas associated with coagulopathy remain sources of high-severity injury.
Authors:
Lorri A Lee; Karen L Posner; Karen B Domino; Robert A Caplan; Frederick W Cheney
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Anesthesiology     Volume:  101     ISSN:  0003-3022     ISO Abbreviation:  Anesthesiology     Publication Date:  2004 Jul 
Date Detail:
Created Date:  2004-06-28     Completed Date:  2004-07-29     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  1300217     Medline TA:  Anesthesiology     Country:  United States    
Other Details:
Languages:  eng     Pagination:  143-52     Citation Subset:  AIM; IM    
Affiliation:
Department of Anesthesiology, University of Washington, Seattle, Washington 98104, USA. lorlee@u.washington.edu
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MeSH Terms
Descriptor/Qualifier:
Adult
Anesthesia, Conduction / adverse effects*
Anesthesia, Obstetrical / adverse effects
Blood Coagulation Disorders / chemically induced,  epidemiology
Brain Damage, Chronic / chemically induced,  epidemiology
Databases, Factual
Eye Injuries / epidemiology
Female
Heart Arrest / chemically induced,  epidemiology
Hematoma / epidemiology,  etiology
Humans
Insurance
Insurance Claim Review / economics,  statistics & numerical data*
Liability, Legal
Malpractice / economics,  statistics & numerical data
Nerve Block / adverse effects
Peripheral Nerves / injuries
Pregnancy
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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