SurveySurvey

Search

ASA Annual Meeting Materials

2011 Materials

  1. Mehta S, Posner KL, Chandanabhumma P, Bhananker SM, Lee LA, Domino KB: Closed Claims Analysis of Cautery Fires in the Operating Room. Anesthesiology A1722, 2011.
  2. Lee L, Posner KL, Kent CD, Fitzgibbon D, Domino KB: Complications and Outcomes for Neuraxial Anesthesia for Surgery: A Closed Claims Analysis. Anesthesiology A415, 2011.

2010 Materials

  1. Bailie R, Stephens L, Warner M, Warner M, Domino K: Liability and risk factors associated with aspiration: closed claims analysis.  Proceedings of the 2010 Annual Meeting of the American Society of Anesthesiologists: A789, 2010
    1. Patients who experienced aspiration of gastric contents were older and sicker than other patients, and were often undergoing emergency or abdominal procedures.  Death was twice as common in aspiration claims as other claims in the ASA Closed Claims Project database.  Aspiration occurred on induction of anesthesia despite the use of RSI with cricoid pressure in almost half of the claims, raising the question of its effectiveness.
  2. Hindman BJ, Posner KL, Todd MM, Lee LA, Domino KB: Cervical cord, root and spine injury: a closed clams analysis.  Proceedings of the 2010 Annual Meeting of the American Society of Anesthesiologists: A778, 2010.
    1. Cervical injury occurred in <1% of all claims for general anesthesia (GA) yet injuries were more often permanent and disabling than other GA claims.  Cord injuries were more severe than root/spine injuries and typically resulted in quadriplegia.  Cord injuries usually occurred in the absence of traumatic injury, cervical spine instability, or airway difficulties, although anatomic abnormalities were present in almost all.  In the absence of instability, degenerative disease of the spine was common and appeared to be the factor underlying cord injury.
  3. Lee LA, Bruchas, R, Posner KL, Caplan RC, Domino KB: Blood pressure management in the beach chair position: national survey results Proceedings of the 2010 Annual Meeting of the American Society of Anesthesiologists: A1133, 2010.
    1. Reports of severe brain damage after shoulder surgery in the beach chair position with deliberate hypotension (DH) have raised concern about blood pressure (BP) management and adequacy of cerebral perfusion pressure in these procedures.  This national survey found that shoulder surgery was more commonly performed in the beach chair than lateral position and that DH was utilized by 28% of respondents. Anesthesia practitioners using DH for shoulder surgery had significantly lower goal BP ranges and use of arterial lines than those not using DH.  Detailed data collection from cases of severe brain damage after surgery in the beach chair position may guide further research into this devastating complication.
  4. Lee LA, Posner KL, Bruchas R, Roth S, Domino KB: Visual loss after prostatectomy.  Proceedings of the 2010 Annual Meeting of the American Society of Anesthesiologists: A1132, 2010.
    1. The increased number of robotic –assisted prostatectomies performed in the steep Trendelenburg position for prolonged durations has raised concern that his procedure may be at high risk of developing ischemic optic neuropathy (ION) with elevated venous pressure in the head.  We identified 6 cases of ION after prostatectomy in the ASA Postoperative Visual Loss Registry.  Three procedures were open (duration 3.2 – 4 hrs) and three were robotic-assisted (duration 7.9-9.9 hrs). Overall, prostatectomy cases with ION were shorter than spine cases with ION, but estimated blood loss, hematocrit and intraoperative blood pressure ranges were not clinically or significantly different.  Both open and robotic-assisted prostatectomy cases are emerging as another type of procedure that may be associated with perioperative ION.

2009 Materials

  1. Fitzgibbon DR, Michna E, Rathmell JP, Stephens LS, Domino KB: Medication management in chronic pain malpractice claims. Anesthesiology 111:A1605, 2009.
    1. Increases in abuse of opioids is a growing public health problem. Most anesthesia malpractice claims for medication management problems involved chronic pain patients with a history of risk behaviors commonly associated with addiction or medication misuse. Malpractice claims arising from medication management had a high proportion of deaths with both patient and physician contributions to the outcome.
  2. Rathmell JP, Michna E, Fitzgibbon DR, Stephens LS, Domino KB: The ASA Closed Claims Project: analysis of chronic pain cervical procedure malpractice claims. Anesthesiology 111:A1041, 2009.
    1. Spinal cord injury was more common after cervical procedures than other pain treatments. Spinal cord injury occurred in just over half of cervical procedure claims and resulted in permanent, disabling injuries in most cases. The proportion of patients who sustained direct trauma to the spinal cord increased in those who received general anesthesia or sedation compared to those who did not receive GA or sedation. Further study is essential to devise means to prevent the devastating neurologic injuries that can occur during pain procedures at the cervical level and to clarify the role that general anesthesia and/or sedation have in the occurrence and severity of injury

2008 Materials

  1. Lee, LA, Fligner CL, Stephens LS, Cheney FW, Domino KB: Role of Autopsy in the ASA Closed Claims Project. Anesthesiology 109: A372, 2008. [Full Abstract Text]
    1. Autopsy was performed in approximately half of all claims associated with death, especially in healthy, younger persons. Autopsy results were useful in detecting unexpected pathology, and identifying significant non-anesthetic contributions to death. Pathological findings from autopsy were frequently useful in the medico-legal defense of anesthesiologists.
  2. Sandnes DL, Stephens LS, Posner KL, Domino KB: Liability Associated with Medication Errors in Anesthesia: Closed Claims Analysis. Anesthesiology 109: A770, 2008. [Full Abstract Text]
    1. Claims related to medication errors had a higher proportion of pediatric patients compared to other claims. Medication errors commonly involved incorrect doses and medication substitution by syringe swaps. Claims related to medication errors had more permanent brain damage compared to other claims and were more often judged to be preventable, representing substandard care.
  3. Morray J, Ramamoorthy C, Haberkern C, Bhanaker S, Posner K: Anesthesia-Related Cardiac Arrest in Children with Heart Disease: Data from the POCA Registry. Anesthesiology 109: A11, 2008. [Full Abstract Text]
    1. Single ventricle and obstructive lesions (particularly aortic stenosis) were the most common type of heart disease in the POCA Registry. Without the necessary denominators, we cannot provide CA incidence for each heart disease lesion. It is noteworthy that CA in heart disease patients was reported more often in the general OR than in the cardiac OR or the cath lab. Such information may aid anesthesiologists in case assignments for infants and children with heart disease.

2007 Materials

  1. Bird M, Caplan RA, Lee LA, Stephens LS, Domino KB: Liability Associated with Acute Pain Management. Anesthesiology 107: A1743, 2007. [Full Abstract Text]
    1. Claims related to acute pain management are a new source of liability for anesthesiologists. While claims for nerve damage, hematomas, and abscesses were more common with regional blocks used for postoperative pain control, claims for death or brain damage formed a third of acute pain claims. Respiratory depression was an important damaging event, and injuries may have been prevented by better use of respiratory monitoring devices.
  2. Liau DW, Fitzgibbon DR, Posner KL, Stephens LS, Domino KB: Trends in Chronic Pain Management Malpractice Claims. Anesthesiology A1892, 2007. [Full Abstract Text]
    1. Liability associated with chronic pain management increased in 1995-2004 compared to 1985-94, with more chronic pain claims and higher payment amounts. Nerve injury (peripheral and spinal cord) increased. Modes of pain management changed, with an increase in medication management and a decrease in blocks and injections.

2006 Materials

  1. Bhananker SM: On-Patient Fires During Monitored Anesthesia Care: Causation and Prevention. VIDEO: On-Patient Fires during Monitored Anesthesia Care. VIDEO Available: On-Patient Fires during Monitored Anesthesia Care
  2. Davies JM, Posner KL, Cheney FW, Domino KB: Anesthesia Malpractice Claims for Newborn Brain Injury in the 1990s. Anesthesiology 105: A7, 2006. [Full Abstract Text]
    1. The findings of this analysis show that anesthesia care is often not in question, reflected by the proportion of claims resulting in no payment. Alleged anesthesia delay is usually based on the 30-minute decision to delivery rule, which may not have been applicable in all the claims. In 2003, the ACOG Task Force introduced modified criteria to help define the causal relationship between acute intrapartum events and cerebral palsy.4 Hopefully, these new criteria will be positively reflected in future malpractice claims.
  3. Posner KL, Cheney FW, Domino KB: Anesthesia vs. Neurosurgery Malpractice Liability. Anesthesiology 105: A144, 2006. [Full Abstract Text]
    1. PIAA data suggests that neurosurgery claims resulted in higher payments than anesthesia claims. This may reflect the higher proportion of neurosurgery claims for permanent and disabling injuries, which typically result in compensation for lifelong care. ASA Closed Claims Project data compared favorably to PIAA data.
  4. Liau DW, Kooner PK, Posner KL, Cheney FW, Domino KB: Injuries and Liability Related to Peripheral Catheters: A Closed Claims Analysis. Anesthesiology 105: A945, 2006. [Full Abstract Text]
    1. Although limits inherent to the Closed Claims Project exist,1,2 this analysis of peripheral catheter claims has identified important mechanisms of injury and types of complications. Arm tucking and the inability to monitor IV catheters during cardiac surgery may explain why this was the most common surgical group among IV claims. Thiopental was the most commonly reported drug in skin slough claims; reduction in its use may result in fewer IV-related claims. There were few claims secondary to A-lines. Burn injuries from heat compresses used to treat IV infiltrations should be easily preventable.
  5. Kent CD, Posner KL, Cheney FW, Lee LA, Domino KB: Update on Closed Claims for Awareness during General Anesthesia. Anesthesiology 105: A1548, 2006. [Full Abstract Text]
    1. Payments for recall and awake paralysis were not increased over the 1990s, and were similar to those from previous decades. 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

2005 Materials

  1. Lee LA, Roth S, Posner, KL, Cheney, FW, Domino, KB: "An Analysis of 71 Spine Cases with Ischemic Optic Neuropathy from the ASA Postoperative Visual Loss Registry." Anesthesiology 103: A1, 2005. [Full Abstract Text]
    1. Although most ION cases in the ASA POVL Registry were associated with prolonged prone spine surgery (≥ 6 hrs), large blood loss (≥ 1 L), and SBP ≤ 100 mm Hg, the wide ranges in these variables suggests a multi-factorial etiology for ION, and may include unseen patient factors.
  2. Bhananker SM, Ramamoorthy R, Posner, KL, Domino KB, Morray JP: Changing Profile of Anesthesia-Related Cardiac Arrests in Children: Update from Pediatric Peri-Operative Cardiac Arrest (POCA) Registry. Anesthesiology 103: A1310, 2005. [Full Abstract Text]
    1. We observed a reduction in the proportion of medication-related arrests in the last 6 years of the POCA Registry and a decrease in the proportion of infants. The reasons for these changes are unclear.
  3. Jimenez N, Posner KL, Domino KB, Cheney FW: "Trends in Pediatric Anesthesia Malpractice Claims over Three Decades." Anesthesiology 103: A1309, 2005. [Full Abstract Text]
    1. Pediatric anesthesia malpractice claims suggest a reduction in death and permanent brain damage over time. Respiratory events also declined. These changes may reflect increased safety or changing legal strategies.

2004 Materials

  1. Davies JM, Ross BK, Posner KL, Domino KB: Trends in Obstetric Anesthesia Malpractice Claims over the Last Three Decades. Anesthesiology 101: A1231, 2004. [Full Abstract Text]
    1. The proportion of OB anesthesia claims associated with regional anesthesia increased over the decades. This may reflect changes in practice and may account for the reduction in maternal death and newborn brain injury claims and the increase in claims for maternal nerve injury and back pain.
  2. Kressin KA, Posner KL, Lee LA, Cheney FW, Domino KB: Burn Injury in the OR: A Closed Claims Analysis.Anesthesiology, 101: A1282, 2004. [Full Abstract Text]
    1. Burn injuries in the Closed Claims database continue to occur primarily from cautery, warming devices and airway fires. Burns from cautery fires, especially to the face, have increased in the 1990s.
  3. Posner KL, Domino KB, Polissar NJ, Conrad DA, Cheney FW: Trends in Anesthesia Malpractice Lawsuit Payments. Anesthesiology, 101: A1405, 2004. [Full Abstract Text]
    1. Payments in anesthesia malpractice lawsuits declined between the 1970s and 1990s, even when adjusted for changes in standard of care and outcome.

2003 Materials

  1. Bhananker SM, Posner KL, Domino KB, Lee LA, Cheney FW: Liability Associated with Monitored Anesthesia Care: ASA Closed Claims Project. Anesthesiology, 99: A1356, 2003. [Full Abstract Text]
    1. Litigation associated with MAC increased in the 1990s, perhaps reflecting an increase in surgery performed under MAC. Injuries during MAC were as severe and payments to the plaintiff were as high as for injuries during GA. These data suggest that MAC poses significant risk, especially for elderly and chronically ill patients.
  2. Lee LA, Posner KL, Cheney FW, Domino KB: ASA Closed Claims Project: An Analysis of Claims Associated with Neurosurgical Anesthesia. Anesthesiology, 99: A362, 2003. [Full Abstract Text]
    1. Neurosurgical cases comprised only 7% of claims in the ASA Closed Claims database, but had higher liability compared to Other Claims. Death and brain damage, eye and nerve damage, air emboli, inadequate fluids, and positioning injuries were more common in neurosurgical claims compared to Other Claims.
  3. Peterson GN, Posner KL, Domino KB, Lee LA, Cheney FW: Management of the Difficult Airway in Closed Malpractice Claims. Anesthesiology, 99: A1252, 2003. [Full Abstract Text]
    1. Difficult airway claims are associated with severe injury, death and high levels of liability payment. Severe outcomes were more common in the setting of difficult mask ventilation, “can’t intubate/can’t ventilate”, and persistent intubation attempts.
  4. Sharar SR, Tsai YK, Posner KL, Domino KB, Cheney FW: Do Liability and Patient Injuries for Anesthetic Care of Acute Trauma Differ from Those of Non-Trauma Care?: A Closed Claims Analysis. Anesthesiology, 99: A1362, 2003. [Full Abstract Text]
    1. The ASA Closed Claims Project database was analyzed for liability related to acute trauma care. Compared to non-trauma claims, trauma claims involved more emergent and critically ill patients, and resulted in higher mortality and greater median claim payment.

2002 Materials

  1. Spitellie PH, Bowdle TA, Posner KL, Cheney FW, Domino KB: Injuries from Central Lines: A Closed Claims Analysis. Anesthesiology 97: A1124, 2002.
  2. Lee LA, Posner KL, Caplan RA, Domino KB, Cheney FW: ASA Closed Claims Project: An Analysis of Claims Associated with Regional Anesthesia in the Operative Setting 1980-1999. Anesthesiology 97: A-1126, 2002.

2001 Materials

  1. Fitzgibbon DR, Posner KL, Lee LA, Domino KB, Cheney FW: ASA Closed Claims Project: Pain Management in the Non-Surgical Setting 1970-1998. Anesthesiology 95: A957, 2001.

2000 Materials

  1. Uppal M, Posner K, Roth S: Visual Loss Complicating Surgery: Review of 21 Cases. Anesthesiology 93: A1136, 2000.

 

ASA

Link to the ASA Annual Meeting website

 ASA