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Injury and Liability Associated With Spine Surgery

Kutteruf, Rachel, MD; Wells, Deva, MD; Stephens, Linda, PhD; Posner, Karen, L., PhD; Lee, Lorri, A., MD; Domino, Karen, B., MD, MPH

Journal of Neurosurgical Anesthesiology: April 2018 - Volume 30 - Issue 2 - p 156–162
doi: 10.1097/ANA.0000000000000448
Clinical Investigations

Background: Although spine surgery is associated with significant morbidity, the anesthesia liability profile for spine surgery is not known. We examined claims for spine procedures in the Anesthesia Closed Claims Project database to evaluate patterns of injury and liability.

Materials and Methods: A retrospective cohort study was performed. Inclusion criteria were anesthesia claims provided for surgical procedures in 2000 to 2014. We compared mechanisms of injury for cervical spine to thoracic or lumbar spine procedures using χ2 and the Fisher exact test. Univariate and multivariate logistic regression analyses were used to determine factors associated with permanent disabling injury in spine surgery claims.

Results: The 207 spine procedure (73% thoracic/lumbar; 27% cervical) claims comprised >10% of claims. Permanent disabling injuries to nerves, the spinal cord, and the eyes or visual pathways were more common with spine procedures than in nonspine procedures. Hemorrhage and positioning injuries were more common in thoracic/lumbar spine claims, whereas difficult intubation was more common in cervical spine claims. Multiple logistic regression demonstrated prone positioning (odds ratio=3.50; 95% confidence interval, 1.30-9.43) and surgical duration of ≥4 hours increased the odds of severe permanent injury in spine claims (odds ratio=2.73; 95% confidence interval, 1.11-6.72).

Conclusions: Anesthesia claims related to spine surgery were associated with severe permanent disability primarily from nerve and eye injuries. Prone positioning and surgical duration of ≥4 hours were associated with permanent disabling injuries. Attention to positioning, resuscitation during blood loss, and reducing length of surgery may reduce these complications.

Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA

Supported in part by the American Society of Anesthesiologists (ASA) and the Anesthesia Quality Institute (AQI), Schaumburg, IL.

All opinions expressed are those of the authors and do not reflect the policy of the ASA or AQI.

Preliminary findings were accepted for presentation at the American Society of Anesthesiologists annual meeting in San Diego, CA on October 25, 2015.

D.W. received support from the Foundation for Anesthesia Education and Research Medical Student Anesthesia Research Fellowship Summer Program. The remaining authors have no conflicts of interest to disclose.

Address correspondence to: Karen B. Domino, MD, MPH, Department of Anesthesiology and Pain Medicine, University of Washington, Box 356540, Seattle, WA 98195 (e-mail:

Received September 12, 2016

Accepted June 29, 2017

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