Statistical Indiscretions in Papers from the American Society of Anesthesiologists Closed Claims Project

2006 ◽  
Vol 104 (3) ◽  
pp. 615-616 ◽  
Author(s):  
Fredrick K. Orkin
Keyword(s):  
American Society ◽  
Closed Claims ◽  
American Society Of Anesthesiologists

The American Society of Anesthesiologists Closed Claims Project and Its Registries

2008 ◽  
Vol 36 (1) ◽  
pp. 19-31
Author(s):  
Karen B Domino ◽  
Robert A Caplan ◽  
Jeffrey P Morray ◽  
Lorri A Lee
Keyword(s):  
American Society ◽  
Closed Claims ◽  
American Society Of Anesthesiologists

scholarly journals Pulmonary Aspiration of Gastric Contents: A Closed Claims Analysis

2021 ◽  
Author(s):  
Mark A. Warner ◽  
Karen L. Meyerhoff ◽  
Mary E. Warner ◽  
Karen L. Posner ◽  
Linda Stephens ◽  
...  
Keyword(s):  
Anesthetic Management ◽  
Pulmonary Aspiration ◽  
Anesthesia Care ◽  
Inclusion Criteria ◽  
Gastrointestinal Obstruction ◽  
Malpractice Claims ◽  
Gastric Contents ◽  
American Society ◽  
Closed Claims ◽  
American Society Of Anesthesiologists

Background Perioperative pulmonary aspiration of gastric contents has been associated with severe morbidity and death. The primary aim of this study was to identify outcomes and patient and process of care risk factors associated with gastric aspiration claims in the Anesthesia Closed Claims Project. The secondary aim was to assess these claims for appropriateness of care. The hypothesis was that these data could suggest opportunities to reduce either the risk or severity of perioperative pulmonary aspiration. Methods Inclusion criteria were anesthesia malpractice claims in the American Society of Anesthesiologists Closed Claims Project that were associated with surgical, procedural, or obstetric anesthesia care with the year of the aspiration event 2000 to 2014. Claims involving pulmonary aspiration were identified and assessed for patient and process factors that may have contributed to the aspiration event and outcome. The standard of care was assessed for each claim. Results Aspiration of gastric contents accounted for 115 of the 2,496 (5%) claims in the American Society of Anesthesiologists Closed Claims Project that met inclusion criteria. Death directly related to pulmonary aspiration occurred in 66 of the 115 (57%) aspiration claims. Another 16 of the 115 (14%) claims documented permanent severe injury. Seventy of the 115 (61%) patients who aspirated had either gastrointestinal obstruction or another acute intraabdominal process. Anesthetic management was judged to be substandard in 62 of the 115 (59%) claims. Conclusions Death and permanent severe injury were common outcomes of perioperative pulmonary aspiration of gastric contents in this series of closed anesthesia malpractice claims. The majority of the patients who aspirated had either gastrointestinal obstruction or acute intraabdominal processes. Anesthesia care was frequently judged to be substandard. These findings suggest that clinical practice modifications to preoperative assessment and anesthetic management of patients at risk for pulmonary aspiration may lead to improvement of their perioperative outcomes. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

The American Society of Anesthesiologists Closed Claims Project

2010 ◽  
Vol 113 (4) ◽  
pp. 957-960 ◽  
Author(s):  
Frederick W. Cheney ◽  
David S. Warner
Keyword(s):  
American Society ◽  
Closed Claims ◽  
American Society Of Anesthesiologists

Injuries Associated with Regional Anesthesia in the 1980s and 1990s

2004 ◽  
Vol 101 (1) ◽  
pp. 143-152 ◽  
Author(s):  
Lorri A. Lee ◽  
Karen L. Posner ◽  
Karen B. Domino ◽  
Robert A. Caplan ◽  
Frederick W. Cheney
Keyword(s):  
Cardiac Arrest ◽  
Brain Damage ◽  
Regional Anesthesia ◽  
Neuraxial Anesthesia ◽  
Neuraxial Blockade ◽  
Neuraxial Block ◽  
Depth Analysis ◽  
American Society ◽  
Closed Claims ◽  
American Society Of Anesthesiologists

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.

Cervical Radicular Pain

2017 ◽  
Author(s):  
Joshua Horowitz
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Radicular Pain ◽  
Low Back ◽  
Lumbar Radiculopathy ◽  
Disc Protrusion ◽  
Claims Database ◽  
American Society ◽  
Closed Claims ◽  
American Society Of Anesthesiologists

Cervical radicular pain is a common reason for patients in pain to seek care from a pain physician. Differing from low back pain and lumbar radiculopathy, cervical radicular pain is often not related to disc protrusion alone but, rather, a combination of disc and degenerative pathologies, such as uncovertebral hypertrophy and spondylosis. Likewise, the natural history is quite favorable if no treatments are applied, mandating greater safety for the treatments applied. Indeed, the most recent American Society of Anesthesiologists closed claims database report suggests that adverse occurrences from procedural therapies for cervical radicular pain are increasing. This chapter broadly discusses the anatomy, pathophysiology, and various approaches to treatment of these disorders.

Statistical Indiscretions in Papers from the American Society of Anesthesiologists Closed Claims Project

2006 ◽  
Vol 104 (3) ◽  
pp. 616-617 ◽  
Author(s):  
Karen B. Domino ◽  
Gene N. Peterson ◽  
Robert A. Caplan ◽  
Karen L. Posner ◽  
Lorri A. Lee ◽  
...  
Keyword(s):  
American Society ◽  
Closed Claims ◽  
American Society Of Anesthesiologists

Awareness during Anesthesia 

1999 ◽  
Vol 90 (4) ◽  
pp. 1053-1061 ◽  
Author(s):  
Karen B. Domino ◽  
Karen L. Posner ◽  
Robert A. Caplan ◽  
Frederick W. Cheney
Keyword(s):  
General Anesthesia ◽  
Elective Surgery ◽  
Anesthetic Techniques ◽  
Post Traumatic Stress ◽  
Intraoperative Awareness ◽  
Malpractice Claims ◽  
Depth Analysis ◽  
American Society ◽  
Closed Claims ◽  
American Society Of Anesthesiologists

Background Awareness during general anesthesia is a frightening experience, which may result in serious emotional injury and post-traumatic stress disorder. We performed an in-depth analysis of cases from the database of the American Society of Anesthesiologists Closed Claims Project to explore the contribution of intraoperative awareness to professional liability in anesthesia. Methods The database of the Closed Claims Project is composed of closed US malpractice claims that have been collected in a standardized manner. All claims for intraoperative awareness were reviewed by the reviewers to identify patterns of causation and standard of care. Logistic regression analysis was used to identify independent patient and anesthetic factors associated with claims for recall during general anesthesia compared to other general anesthesia malpractice claims. Results Awareness claims accounted for 79 (1.9%) of 4,183 claims in the database, including 18 claims for awake paralysis, i.e., the inadvertent paralysis of an awake patient, and 61 claims for recall during general anesthesia, ie., recall of events while receiving general anesthesia. The majority of awareness claims involved women (77%), younger than 60 yr of age (89%), American Society of Anesthesiologists physical class I-II (68%), who underwent elective surgery (87%). Most (94%) claims for awake paralysis represented substandard care involving errors in labeling and administration, whereas care was substandard in only 43% of the claims for recall during general anesthesia (P < 0.001). Claims for recall during general anesthesia were more likely to involve women (odds ratio [OR] = 3.08, 95% confidence interval [CI] = 1.58, 6.06) and anesthetic techniques using intraoperative opioids (OR = 2.12, 95% CI = 1.20, 3.74), intraoperative muscle relaxants (OR = 2.28, 95% CI = 1.22, 4.25), and no volatile anesthetic (OR = 3.20, 95% CI = 1.88, 5.46). Conclusions Deficiencies in labeling and vigilance were common causes for awake paralysis. Claims for recall during general anesthesia were more likely in women and with nitrous-narcotic-relaxant techniques.

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