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Operating room fires: a closed claims analysis.

Sonya P Mehta1, Sanjay M Bhananker, Karen L Posner

  • 1Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA.

Anesthesiology
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Operating room fires are often caused by electrocautery, especially during monitored anesthesia care. Preventing these fires requires recognizing the fire triad and implementing safety protocols, particularly when using oxygen.

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Area of Science:

  • Anesthesiology
  • Surgical Safety
  • Medical Malpractice

Background:

  • Operating room (OR) fires pose significant risks.
  • Malpractice claims provide insight into OR fire incidents and associated liabilities.

Purpose of the Study:

  • To analyze injury patterns and liability in OR fires.
  • To identify causative factors of OR fires using malpractice claims data.

Main Methods:

  • Reviewed closed malpractice claims from the American Society of Anesthesiologists (ASA) Closed Claims Database since 1985.
  • Compared OR fire claims with non-fire surgical anesthesia claims.
  • Analyzed fire-related claims to determine causative factors.

Main Results:

  • 103 OR fire claims (1.9%) were identified; electrocautery was the ignition source in 90%.
  • Electrocautery fires increased over time, particularly during head, neck, or upper chest procedures (85%) and monitored anesthesia care (81%).
  • Oxygen as an oxidizer (95%), often via an open delivery system (84%), was critical in electrocautery fires.

Conclusions:

  • Electrocautery fires during monitored anesthesia care are the most common OR fire claims.
  • Preventing OR fires necessitates understanding the fire triad (oxidizer, fuel, ignition source), especially the role of supplemental oxygen.
  • Enhanced communication, education, and fire prevention protocols for high-risk procedures are vital.