Neurologic Injury after Non-Supine Shoulder Surgery (NINS) Registry

The Anesthesia Patient Safety Foundation has established this Registry in collaboration with the ASA Closed Claims Project to investigate the mechanism of severe brain and spinal cord damage that has been reported after shoulder surgery in the sitting position. This complication has occurred in both the old and young patient populations. Several theories exist as to the etiology of these catastrophic neurologic injuries including: 1) the loss of venous return and decreased cardiac output in the upright position; 2) loss of a compensatory sympathetic response to positional changes caused by anesthesia; 3) failure to correct for the difference in height between the site of blood pressure measurement and the head level; 4) the use of deliberate or permissive hypotension; 5) dynamic vertebral artery stenosis or occlusion with rotation of the head; and 6) air emboli.   The incidence of  this perioperative complication is unclear, but appears to be low. Thus, reporting these cases through a national voluntary registry will provide the best opportunity to collect enough cases to determine the perioperative characteristics that these cases may share. Until we have better data on this topic, preventative strategies cannot be effectively defined.

Using models developed through the ASA Closed Claims Project, the Neurologic Injury after Non-Supine Shoulder Surgery (NINS) Registry hopes to collect a large number of detailed case reports for analysis. A detailed case report form has been posted on this web site with instructions for anonymous case submission.

Completion of these case reports requires access to the following medical records:

• Preoperative
• Intraoperative
• Anesthesia record
• Postoperative
• PACU record
• Neurologic examination report
• Any pertinent diagnostic studies

The case report form is designed for use by professionals from the anesthesia community, although other health care professionals may be able to assist in its completion.

Case submission is via de-identified records and abstracted data to ensure confidentiality. This study has been approved by the University of Washington IRB.

Inclusion / Exclusion Criteria

Inclusion Criteria:                 

• Shoulder surgery in non-supine position (e.g., beach chair, sitting, lateral)
• Any case of new central (cerebral or spinal cord) neurological injury that occurs within 24 hours of surgery.
• Patient age > 12 years

Exclusion Criteria:

• Any case where direct surgical trauma could cause cerebral or spinal cord injury.
• Perioperative cardiac arrest, intraoperative hypoxic events or uncontrolled surgical hemorrhage.
• Lack of adequate medical records including preoperative history and exam, anesthetic record, and postoperative follow-up and studies. 

Note to patients

The Neurologic Injury after Non-Supine Shoulder Surgery (NINS) Registry is primarily designed to aid physicians in improving their clinical practice. We are sorry we cannot address individual patient questions or provide medical or legal advice.

How care providers can submit cases

If you have a case of severe brain or spinal cord injury after shoulder surgery to report, please download the material below (Requires a PDF Reader) . If you prefer, you can receive this material via US Postal Mail.

 

To receive these materials via US Postal Service, contact:

Karen Posner, Ph.D. Department of Anesthesiology and Pain Medicine University of Washington Box 356540 Seattle, WA 98195-6540 U.S.A. Telephone: (206) 616-2630 Fax: (206) 543-2958 E-mail: posner@uw.edu Download Dr. Posner's vCard:

Lorri A. Lee, M.D. Director, Postoperative Visual Loss Registry Department of Anesthesiology and Pain Medicine University of Washington Box 356540 Seattle, WA 98195-6540 U.S.A. E-mail: lorlee@uw.edu

www.asaclosedclaims.org