Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States of America.
Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States of America; Center for Perioperative Research, Brigham and Women's Hospital, Boston, MA, United States of America.
J Clin Anesth. 2018 Nov;50:48-56. doi: 10.1016/j.jclinane.2018.06.038. Epub 2018 Jun 29.
The aim of this study is to provide a contemporary medicolegal analysis of claims brought against anesthesiologists in the United States for events occurring in the post-anesthesia care unit (PACU).
In this retrospective analysis, we analyzed closed claims data from the Controlled Risk Insurance Company (CRICO) Comparative Benchmarking System (CBS) database.
Claims closed between January 1, 2010 and December 31, 2014 were included for analysis if the alleged damaging event occurred in a PACU and anesthesiology was named as the primary responsible service.
Forty-three claims were included for analysis. Data regarding ASA physical status and comorbidities were obtained, whenever available. Ages ranged from 18 to 94. Patients underwent a variety of surgical procedures. Severity of adverse outcomes ranged from temporary minor impairment to death.
Patients receiving care in the PACU.
Information gathered for this study includes patient demographic data, alleged injury type and severity, operating surgical specialty, contributing factors to the alleged damaging event, and case outcome. Some of these data were drawn directly from coded variables in the CRICO CBS database, and some were gathered by the authors from narrative case summaries.
Settlement payments were made in 48.8% of claims. A greater proportion of claims involving death resulted in payment compared to cases involving other types of injury (69% vs 37%, p = 0.04). Respiratory injuries (32.6% of cases), nerve injuries (16.3%), and airway injuries (11.6%) were common. Missed or delayed diagnoses in the PACU were cited as contributing factors in 56.3% of cases resulting in the death of a patient. Of all claims in this series, 48.8% involved orthopedic surgery.
The immediate post-operative period entails significant risk for serious complications, particularly respiratory injury and complications of airway management. Appropriate monitoring of patients by responsible providers in the PACU is crucial to timely diagnosis of potentially severe complications, as missed and delayed diagnoses were a factor in a number of the cases reviewed.
本研究旨在对美国麻醉医师在麻醉后护理单元（PACU）发生的事件提出的索赔进行当代法医学分析。
在这项回顾性分析中，我们分析了受控风险保险公司（CRICO）比较基准系统（CBS）数据库中的封闭索赔数据。
如果被指控的损害事件发生在 PACU 且麻醉被命名为主要责任服务，2010 年 1 月 1 日至 2014 年 12 月 31 日期间关闭的索赔将被纳入分析。
共有 43 项索赔被纳入分析。只要有可能，就获得了有关 ASA 身体状况和合并症的数据。患者年龄在 18 至 94 岁之间。患者接受了各种手术。不良后果的严重程度从暂时轻微损伤到死亡不等。
在 PACU 接受治疗的患者。
本研究收集的信息包括患者人口统计学数据、指控的伤害类型和严重程度、手术专业、导致指控的损害事件的因素以及案件结果。这些数据中的一些直接取自 CRICO CBS 数据库中的编码变量，而另一些则由作者从叙述性案例摘要中收集。
48.8%的索赔支付了和解金。与涉及其他类型伤害的案件相比，涉及死亡的索赔更有可能支付（69%对 37%，p=0.04）。呼吸损伤（32.6%的病例）、神经损伤（16.3%）和气道损伤（11.6%）较为常见。PACU 中漏诊或延迟诊断被列为导致患者死亡的 56.3%病例的促成因素。在本系列所有索赔中，48.8%涉及骨科手术。
术后即刻期间存在严重并发症的重大风险，特别是呼吸损伤和气道管理并发症。在 PACU 中，负责任的提供者对患者进行适当监测对于及时诊断潜在严重并发症至关重要，因为在审查的许多病例中，漏诊和延迟诊断都是一个因素。
