A contemporary medicolegal claims analysis of injuries related to neuraxial anesthesia between 2007 and 2016

Study objective: To provide a contemporary medicolegal analysis of claims brought against anesthesia providers in the United States related to neuraxial blocks for surgery and obstetrics. Design: In this retrospective analysis, we analyzed closed claims data from the Controlled Risk Insurance Company (CRICO) Comparative Benchmarking System (CBS) database between 2007 and 2016. Setting: Closed claims from inpatient and outpatient settings related to neuraxial anesthesia for surgical procedures and obstetrics. Patients: Forty-five claims were identified for analysis. These patients underwent a variety of surgical procedures, included both children and adults, and with ages ranging from 6 to 82. Interventions: Patients receiving neuraxial anesthesia (spinals, epidurals) for surgery or obstetrics. Measurements: Data collected includes patient demographics, alleged injury type/severity, surgical specialty, likely contributors to the alleged damaging event, and case outcome. Some of the data were drawn directly from coded variables in the CRICO database, and some were gathered from narrative case summaries. Main results: Settlement payments were made in 20% of claims. Reported adverse outcomes ranged from temporary minor to permanent major injuries. Most closed claims were classified as permanent minor injuries. The greatest number of claims involved residual weakness and radiculopathy resulting from epidurals. The largest contributing factor to these injuries was noted to be “Technical Knowledge/Performance” of the anesthesia provider followed by “Missing or Documentation Error.” Over half of the claims arose from obstetric patients (31%) and patients undergoing orthopedic surgery (27%). Conclusions: Patients with pre-existing radiculopathy or comorbidities may warrant more thorough informed consent about the increased risk of injury. Additionally, prompt follow-up, monitoring, and documentation of post-operative symptoms, such as weakness or radiculopathy, are crucial for improving patient safety and satisfaction. More timely communication with the patient and the surgical team regarding residual neurologic symptoms is important for earlier diagnosis of injury.