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

Data collection for the Neurologic Injury After Non-Supine Shoulder Surgey (NINS) Registry is now closed.

The Anesthesia Patient Safety Foundation and the ASA Committee on Professional Liability initially funded this Registry in collaboration with the Anesthesia 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 old and young patients.

The etiology of these catastrophic neurological injuries is unknown. Several theories speculate about the role of deliberate or permissive hypotension, cerebral perfusion in the beach chair position, dynamic vertebral artery stenosis or occlusion with rotation of the head, air emboli, or other factors. The incidence of this perioperative complication is unclear, but appears to be low. Thus, reporting these cases through a national voluntary registry provided 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 Anesthesia Closed Claims Project, the Neurologic Injury after Non-Supine Shoulder Surgery (NINS) Registry collected detailed case reports for analysis.