Ophthalmic Consultants of Boston, Harvard Medical School, Boston, Massachusetts.
Ophthalmic Mutual Insurance Company, San Francisco, California.
Ophthalmology. 2020 Jul;127(7):852-858. doi: 10.1016/j.ophtha.2019.12.019. Epub 2019 Dec 25.
To evaluate the types of anesthesia-related closed claims and their contributing factors, using data from the Ophthalmic Mutual Insurance Company (OMIC).
Retrospective analysis of preexisting data.
Plaintiffs who filed a professional liability claim or suit (written demand for money) against OMIC-insured ophthalmologists, ophthalmic practices, or surgicenters in which the surgical case occurred.
Plaintiff claims were collected from the OMIC database from 2008 to 2018 using search queries for terms associated with known complications of ophthalmic anesthesia.
Number and types of anesthesia-related injuries and claims, who administered the anesthesia, the outcomes of the claim or suit, cost to defend, and payments made to plaintiffs.
Sixty-three anesthesia-related claims or suits were filed by 50 plaintiffs. Anesthesia-related injuries included globe perforation (n = 17), death (n = 13), retrobulbar hemorrhage (n = 7), optic nerve damage (n = 4), vascular occlusions (n = 2), pain (n = 2), eye or head movement resulting in injury (n = 2), and 1 case each for numbness, diplopia, and tooth loss during intubation. All but 1 patient who died had preexisting, significant comorbidities. Two deaths were related to brainstem anesthesia. Regarding the type of anesthesia in the closed claims, retrobulbar and peribulbar anesthesia were the most common types (n = 16 each), followed by local infiltration around the lids and facial nerve (n = 6), topical anesthesia (n = 5), and general anesthesia (n = 5). In 2 cases, the exact type of anesthesia was unknown but not general. The 5 topical with sedation anesthesia-related claims were due to inadequate pain control (n = 2), ocular movement resulting in capsular rupture (n = 2), or death (n = 1) allegedly related to excessive or inadequate monitoring of sedation. There were 5 claims related to general anesthesia including 4 deaths and 1 tooth loss during intubation. Sedation was alleged to be a factor in 5 cases resulting in death. Anticoagulants were a factor in 3 retrobulbar hemorrhage cases.
Although claims and suits were infrequent given the large number of insured ophthalmologists and the large number of surgical cases requiring various types of anesthesia performed over the 10.5-year study period, severe injuries can occur.
利用眼科互助保险公司（OMIC）的数据，评估与麻醉相关的理赔类型及其促成因素。
对预先存在数据的回顾性分析。
针对 OMIC 保险的眼科医生、眼科诊所或手术中心提起专业责任索赔或诉讼（书面索偿要求）的原告，这些诉讼中的手术案例发生在这些机构。
使用与眼科麻醉已知并发症相关的术语，从 2008 年至 2018 年，从 OMIC 数据库中收集原告索赔。
与麻醉相关的伤害和索赔数量和类型、实施麻醉的人员、索赔或诉讼的结果、辩护费用以及向原告支付的款项。
50 名原告共提出 63 项与麻醉相关的索赔或诉讼。与麻醉相关的伤害包括眼球穿孔（n=17）、死亡（n=13）、球后出血（n=7）、视神经损伤（n=4）、血管阻塞（n=2）、疼痛（n=2）、眼部或头部运动导致损伤（n=2），以及插管期间出现麻木、复视和牙齿脱落各 1 例。除 1 名死亡患者外，所有患者均有先前存在的严重合并症。2 例死亡与脑干麻醉有关。关于封闭索赔中的麻醉类型，球后和球周麻醉最为常见（各 16 例），其次是眼睑周围和面神经局部浸润（各 6 例）、局部浸润麻醉（各 5 例）和全身麻醉（各 5 例）。在 2 例中，确切的麻醉类型未知，但不是全身麻醉。5 例局部浸润麻醉伴镇静相关索赔的原因是疼痛控制不足（n=2）、眼球运动导致囊膜破裂（n=2）或据称与镇静监测不足或过度相关的死亡（n=1）。与全身麻醉相关的索赔有 5 例，包括 4 例死亡和 1 例插管时牙齿脱落。在导致死亡的 5 例中，有 5 例被指控与镇静有关。抗凝剂是 3 例球后出血的一个促成因素。
尽管考虑到在研究的 10.5 年期间，受保眼科医生数量众多，需要进行各种类型麻醉的手术案例数量众多，因此此类索赔和诉讼的数量很少，但仍可能发生严重伤害。
