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. 2019 Dec;58:84-90. doi: 10.1016/j.jclinane.2019.05.013. Epub 2019 May 22.
To provide an analysis of closed malpractice claims brought against anesthesiologists for positioning-related perioperative nerve injury (PRPNI).
In this retrospective study, we analyzed closed claims data from the Controlled Risk Insurance Company (CRICO) Comparative Benchmarking System (CBS) database.
Closed claims involving nerve injuries that occurred between January 1, 1996 and December 31, 2015 in all surgical settings, provided the alleged damaging event occurred under general anesthesia.
Patient ages ranged from 23 to 94. Patients underwent a variety of surgical procedures. Severity of nerve injury ranged from "Insignificant" to "Grave" according to the NAIC Severity of Injury Code.
None.
Patient age and gender, alleged nerve injury type and severity, operating surgical specialty, contributing factors to the alleged nerve injury, and case outcome. Some of these data were drawn directly from coded variables in the CBS database, and some were gathered by the authors from CRICO-encoded narrative case summaries.
Seventy-five claims were determined to represent PRPNI. Ninety-two percent of all PRPNI claims involved practitioner technical knowledge/performance. Of all the recorded nerve injuries in this series, 56% involved brachial plexus injuries, and supine patient positioning represented 55% of brachial plexus claims. Settlement payments were made in 33% of claims, and the average payment for all cases was $46,269. Twenty-four percent of PRPNI claims were found to be temporary, while 76% were permanent.
PRPNI is multifactorial, and stems both from practitioner errors as well as from patient comorbidities and pre-existing neuropathies. Supine positioning can increase PRPNI risk. There are likely still causes of PRPNI of which we are not yet aware, given that despite concerted efforts towards positioning and padding interventions, injuries such as those described in this study still occur.
对涉及麻醉医师因体位相关围手术期神经损伤（PRPNI）的医疗事故进行分析。
本回顾性研究分析了受控风险保险公司（CRICO）比较基准系统（CBS）数据库中的医疗事故报告。
所有外科环境中，1996 年 1 月 1 日至 2015 年 12 月 31 日期间发生的涉及神经损伤的医疗事故报告，只要涉嫌造成伤害的事件发生在全身麻醉下即可。
患者年龄从 23 岁至 94 岁不等。患者接受了各种外科手术。根据国家意外伤害赔偿协会（NAIC）损伤严重程度编码，神经损伤的严重程度从“无明显”到“严重”不等。
无。
患者年龄和性别、涉嫌神经损伤类型和严重程度、手术操作的外科专业、涉嫌神经损伤的促成因素以及案件结果。这些数据中的一些是直接从 CBS 数据库中的编码变量中提取的，还有一些是作者从 CRICO 编码的案例摘要中收集的。
确定了 75 份报告代表 PRPNI。所有 PRPNI 报告中，92%涉及医务人员的技术知识/操作。在本系列记录的所有神经损伤中，56%涉及臂丛神经损伤，仰卧位患者体位占臂丛神经损伤报告的 55%。33%的索赔要求得到了赔偿，所有案件的平均赔偿金额为 46269 美元。24%的 PRPNI 索赔被认为是暂时的，而 76%是永久性的。
PRPNI 是多因素的，不仅源于医务人员的失误，还源于患者的合并症和先前存在的神经病变。仰卧位可增加 PRPNI 的风险。尽管我们已经采取了体位和衬垫干预措施，但仍有可能存在我们尚未意识到的 PRPNI 原因，因为尽管我们已经做出了协调一致的努力，但在本研究中仍有此类损伤发生。
