Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States of America.
CRICO Strategies, Boston, MA, United States of America.
J Clin Anesth. 2019 Nov;57:66-71. doi: 10.1016/j.jclinane.2019.03.013. Epub 2019 Mar 12.
To provide a contemporary medicolegal analysis of claims brought against anesthesia providers in the United States related to neuraxial blocks for surgery and obstetrics.
In this retrospective analysis, we analyzed closed claims data from the Controlled Risk Insurance Company (CRICO) Comparative Benchmarking System (CBS) database between 2007 and 2016.
Closed claims from inpatient and outpatient settings related to neuraxial anesthesia for surgical procedures and obstetrics.
Forty-five claims were identified for analysis. These patients underwent a variety of surgical procedures, included both children and adults, and with ages ranging from 6 to 82.
Patients receiving neuraxial anesthesia (spinals, epidurals) for surgery or obstetrics.
Data collected includes patient demographics, alleged injury type/severity, surgical specialty, likely contributors to the alleged damaging event, and case outcome. Some of the data were drawn directly from coded variables in the CRICO database, and some were gathered from narrative case summaries.
Settlement payments were made in 20% of claims. Reported adverse outcomes ranged from temporary minor to permanent major injuries. Most closed claims were classified as permanent minor injuries. The greatest number of claims involved residual weakness and radiculopathy resulting from epidurals. The largest contributing factor to these injuries was noted to be "Technical Knowledge/Performance" of the anesthesia provider followed by "Missing or Documentation Error." Over half of the claims arose from obstetric patients (31%) and patients undergoing orthopedic surgery (27%).
Patients with pre-existing radiculopathy or comorbidities may warrant more thorough informed consent about the increased risk of injury. Additionally, prompt follow-up, monitoring, and documentation of post-operative symptoms, such as weakness or radiculopathy, are crucial for improving patient safety and satisfaction. More timely communication with the patient and the surgical team regarding residual neurologic symptoms is important for earlier diagnosis of injury.
对美国与手术和产科相关的脊神经阻滞麻醉提供者相关的麻醉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 2007 年至 2016 年期间受控风险保险公司（CRICO）比较基准系统（CBS）数据库中的封闭索赔数据。
与手术和产科脊神经麻醉相关的住院和门诊封闭索赔。
确定了 45 个索赔进行分析。这些患者接受了各种手术，包括儿童和成人，年龄从 6 岁到 82 岁不等。
接受脊神经麻醉（脊椎、硬膜外麻醉）进行手术或产科的患者。
收集的数据包括患者人口统计学特征、涉嫌伤害类型/严重程度、外科专业、涉嫌损害事件的可能促成因素以及病例结果。一些数据直接来自 CRICO 数据库中的编码变量，一些数据来自叙述性病例摘要。
20%的索赔获得和解付款。报告的不良后果从暂时轻微到永久性严重损伤不等。大多数封闭的索赔被归类为永久性轻微损伤。涉及硬膜外麻醉后残留无力和根神经病的索赔最多。这些损伤的最大促成因素被认为是麻醉提供者的“技术知识/表现”，其次是“缺失或文件错误”。超过一半的索赔来自产科患者（31%）和接受骨科手术的患者（27%）。
患有先前存在的根神经病或合并症的患者可能需要更彻底的知情同意，以了解增加的受伤风险。此外，及时对术后症状（如无力或根神经病）进行随访、监测和记录，对于提高患者安全性和满意度至关重要。与患者和外科团队更及时地沟通关于残留神经症状的问题，对于早期诊断损伤非常重要。
