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Citation
Kent CD, Posner KL, Cheney FW, Lee LA, Domino KB: Update on Closed Claims for Awareness during General Anesthesia. Anesthesiology 105: A1548, 2006.
Abstract
Background
Awareness during general anesthesia has recently commanded public and scientific attention. We reviewed the ASA Closed Claims database1 to evaluate changes in liability for awareness and factors associated with anesthesia claims in the 1990s.
Methods
Anesthesia malpractice claims for awareness were collected from throughout the U.S. as previously described.1 Claims for awareness were classified into awake paralysis and recall under general anesthesia. Standard of care was assessed using reasonable and prudent criteria.1 Differences in characteristics and payments between recall and other general anesthesia (GA) claims were compared by Fisher's Exact Test with p<0.05 considered significant. Payments in 1990-1994 and 1995-2001 were adjusted to 1999 dollars using the Consumer Price Index2 and compared with the Mann-Whitney U test.
Results
In the 1990s, awareness claims formed 2% of claims in the ASA Closed Claims database with 56 claims for recall and 9 claims for awake paralysis. All but one of the awake paralysis claims involved succinylcholine and half were syringe swaps. In 11% of recall claims, the patient exhibited hypotension and was unable to tolerate sufficient amounts of anesthetic agents to prevent recall. In another 9%, vaporizor or ventilator malfunction contributed to light anesthesia. Nearly a quarter of recall claims involved cardiac surgery (23% vs. 6% for other GA claims, p<0.05). Most recall claims involved female patients (73% vs. 52%, p<0.05). Care met standards in about half of recall claims. Payment was made in approximately half of claims, but median payments were lower than other GA claims (p<0.05). Payments for recall did not differ between the two time periods (Table).
Claims 1990-1994 |
Claims 1995-2001 |
|||
|---|---|---|---|---|
Recall (n=25) |
All GA (n=954) |
Recall (n=24) |
All GA (n=780) |
|
Payment (%) |
64% |
52% |
40% |
50% |
Median Payment |
$44,025 |
$158,750* |
$26,550 |
$145,300* |
*p<0.05 compared to recall during same time period; payments are 1999 dollar amounts; missing data excluded
Discussion
Payments for recall and awake paralysis were not increased over the 1990s, and were similar to those from previous decades.3 Awake paralysis continues to be a low frequency but preventable problem as the majority of these claims are due to syringe swap errors. More claims for recall were associated with cardiac surgery than previously reported.3 The increased attention by the media of the last few years toward the problem of awareness during general anesthesia and the use of the BIS monitor in clinical practice post-dates the claims reviewed here. Any impact that those factors may have on the recall liability burden remains to be seen.
References
- JAMA 1989; 261:1599
- U.S. Bureau of Labor Statistics Inflation Calculator, http://www.dol.gov/dol/topic/statistics/inflation.htm
- Anesthesiology 1999; 90:1053.
A copy of the full text can be obtained from the American Society of Anesthesiologists, 520 N. Northwest Highway, Park Ridge, Illinois 60068-2573. Reprinted with permission of Lippincott Williams & Wilkins.