What Adverse Events and Injuries Are Cited in Anesthesia Malpractice Claims for Nonspine Orthopaedic Surgery?

Area of Science:

• Anesthesiology
• Orthopaedic Surgery
• Patient Safety
• Medical Malpractice

Background:

• Malpractice claims in orthopaedic surgery often involve both orthopaedic surgeons and anesthesiologists.
• The Anesthesia Closed Claims database offers insights into patient safety events and shared medicolegal liability.

Purpose of the Study:

• To compare orthopaedic anesthesia malpractice claims with other anesthesia claims regarding patient/case characteristics, events, injuries, and liability.
• To identify characteristics of patients experiencing neuraxial hematomas, central ischemic neurologic injury (beach chair position), and postoperative respiratory events.

Main Methods:

• Analysis of the Anesthesia Closed Claims Project database (2000-2013) for non-spine orthopaedic surgery claims (n=475) versus other procedures (n=1592).
• In-depth review of high-impact injury claims: neuraxial hematoma (n=10), central ischemic neurologic injury (beach chair, n=9), and postoperative respiratory depression (n=23).

Main Results:

• Orthopaedic anesthesia claims showed higher rates of nerve injuries (26% vs. 14%) and regional anesthesia events (26% vs. 6%) compared to other claims.
• Neuraxial hematoma patients (90%) were on anticoagulants, all had severe injuries, and diagnosis was often delayed.
• Postoperative respiratory events predominantly occurred after lower extremity procedures (87%) and on the day of surgery or first postoperative day (96%).

Conclusions:

• Orthopaedic anesthesia malpractice claims more frequently involve nerve injury and regional anesthesia events, possibly due to higher regional anesthesia use.
• Concurrent neuraxial procedures and anticoagulation require clear care coordination and prompt neurological assessment.
• Enhanced monitoring for patients in the beach chair position and those on multiple postoperative opioids is recommended.