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The risk and safety of anesthesia at remote locations: the US closed claims analysis

Metzner, Julia; Posner, Karen L; Domino, Karen B

Current Opinion in Anaesthesiology:
doi: 10.1097/ACO.0b013e32832dba50
Anesthesia outside the operating room: Edited by Alwin E. Goetz
Abstract

Purpose of review: A growing number of procedures are performed outside the operating room. In spite of their relatively noninvasive nature, serious adverse outcomes can occur. We analyzed claims from 1990 and later in the American Society of Anesthesiologists Closed Claims database to assess patterns of injury and liability associated with claims from anesthesia in remote locations (n = 87) compared with claims from operating room procedures (n = 3287).

Recent findings: Compared with operating room claims, remote location claims involved older and sicker patients (P < 0.01), with 50% of remote location claims involving monitored anesthesia care. The proportion of claims for death was increased in remote location claims [54 vs. 29% (operating room claims), P < 0.001]. Respiratory damaging events were more common in remote location claims (44 vs. 20%, P < 0.001), with inadequate oxygenation/ventilation the most common specific event (21 vs. 3% in operating room claims, P < 0.001). Remote location claims were more often judged as being preventable by better monitoring (32 vs. 8% for operating room claims, P < 0.001).

Conclusion: Data from the American Society of Anesthesiologists, Closed Claims database suggest that anesthesia at remote locations poses a significant risk for the patient, particularly related to oversedation and inadequate oxygenation/ventilation during monitored anesthesia care. Similar anesthesia and monitoring standards and guidelines should be used in all anesthesia care areas.

Author Information

Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, Washington, USA

Correspondence to Karen B. Domino, MD, MPH, Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, 1959 NE Pacific Street, Box #356540, Seattle, WA 98195-6540, USA Tel: +1 206 616 2627; fax: +1 206 543 2958; e-mail: kdomino@u.washington.edu

© 2009 Lippincott Williams & Wilkins, Inc.