Analysis of Deaths Related to Anesthesia in the Period 1996–2004 from Closed Claims Registered by the Danish Patient Insurance Association

Hove, Lars Dahlgaard; Steinmetz, Jacob; Christoffersen, Jens; Møller, Ann Merete; Nielsen, Janni; Schmidt, Henrik

doi:10.1097/01.anes.0000264749.86145.e5

Cited by 109 publications

(57 citation statements)

References 9 publications

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“…Although the majority of evidence suggests that combined anesthesia reduces the number of deaths [19][20][21][22] , one previous study has demonstrated increased mortality among patients given this type of anesthesia 23 . Obese patients are susceptible to ineffective coughing, basal atelectasis and progressive hypoxia, facilitating infection 13 .…”

Section: Discussionmentioning

confidence: 98%

Valor dos achados clínicos e da avaliação funcional pulmonar pré-operatórios como preditores das complicações pulmonares pós-operatórias

Silva¹,

Gazzana²,

Knorst³

2010

Rev. Assoc. Med. Bras.

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objectIve. To assess the relationship of clinical data and the results of preoperative pulmonary functional evaluation with postoperative pulmonary complications. Methods. We conducted a retrospective cohort study with patients who underwent pulmonary functional evaluation over a period of 5 years. We analyzed clinical, demographic and spirometric data, surgical procedures performed and postoperative pulmonary complications. results. We analyzed the medical records of 521 patients. Mean age was 59.5 ± 14 years, 65.8% were male, and 93.4% were white. Mean FEV1 was 76.6 ± 24.6% of predicted. There were clinical comorbidities in 73.5% of all cases (COPD in 29.8%). The most common surgical sites were thorax (n = 122; 23.4%) and upper abdomen (n = 117; 22.5%). Postoperative pulmonary complications occurred in 99 patients (19.0%), with respiratory failure being the most common (4.6%). Forty-three (8.3%) patients died. Rates of pulmonary complications were higher after thoracic (28.9%), cardiac (28%) and upper abdomen surgery (24.3%) (p≤0.0001). Most patients (66.7%) with pulmonary complications were classified as ASA III or IV (p<0.01), and in 70.2% of operations, time on anesthesia was > 3.5 hours (p≤0.0001). The difference in median length of hospital stay between patients with and without pulmonary complications was statistically significant (23.5 [15.8-34] days vs. 10 [6-18] days; p<0.001). Patients who had never smoked had fewer complications than those with current or past smoking history (p=0.04). We did not detect significant associations between postoperative pulmonary complications and presence of COPD, FEV1 or body mass index (p>0.05). conclusIon. The most important factors associated with postoperative pulmonary complications were surgical site, time of anesthesia, and ASA classification.

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Section: Discussionmentioning

confidence: 98%

Valor dos achados clínicos e da avaliação funcional pulmonar pré-operatórios como preditores das complicações pulmonares pós-operatórias

Silva¹,

Gazzana²,

Knorst³

2010

Rev. Assoc. Med. Bras.

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“…A closed claims study analyzing deaths related to anesthesia in the period 1996 -2004 in Denmark did not identify any cases of suspected perioperative anaphylaxis leading to a claim in the patient insurance association. 35 Data on mortality from anaphylaxis during anesthesia varies in the literature, but because of the rarity of these events and the many potential sources of error in obtaining mortality data, it is uncertain whether there are differences in mortality in different countries. It is, however, important to note that geographic differences exist in the causes found on investigation of anaphylaxis during anesthesia.…”

Section: Discussionmentioning

confidence: 99%

Treatment with Epinephrine (Adrenaline) in Suspected Anaphylaxis during Anesthesia in Denmark

et al. 2011

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Background: Literature on the use of epinephrine in the treatment of anaphylaxis during anesthesia is very limited. The objective of this study was to investigate how often epinephrine is used in the treatment of suspected anaphylaxis during anesthesia in Denmark and whether timing of treatment is important. Methods: A retrospective study of 270 patients investigated at the Danish Anaesthesia Allergy Centre after referral due to suspected anaphylaxis during anesthesia was performed. Reactions had been graded by severity: C1, mild reactions; C2, moderate reactions; C3, anaphylactic shock with circulatory instability; C4, cardiac arrest. Use of epinephrine, dosage, route of administration, and time between onset of circulatory instability and epinephrine administration were noted. Results: A total of 122 (45.2%) of referred patients had C3 or C4 reactions; of those, 101 (82.8%) received epinephrine. Route of administration was intravenous in 95 (94%) patients. Median time from onset of reported hypotension to treatment with epinephrine was 10 min (range, 1-70 min). Defining epinephrine treatment less than or equal to 10 min

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“…Hove et al [50] examined claims from the Danish Patient Insurance Association, (a national no-fault compensation scheme) over a 9-year period (1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004). In Denmark approximately 400 000 anaesthetic events take place per year.…”

Section: ó 2009 the Authorsmentioning

confidence: 99%

Litigation related to anaesthesia: an analysis of claims against the NHS in England 1995–2007

et al. 2009

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SummaryThe distribution of medico-legal claims in English anaesthetic practice is unreported. We studied National Health Service Litigation Authority claims related to anaesthesia since 1995. All claims were reviewed by three clinicians and variously categorised, including by type of incident, claimed outcome and cost. Anaesthesia-related claims account for 2.5% of all claims and 2.4% of the value of all claims. Of 841 relevant claims 366 (44%) were related to regional anaesthesia, 245 (29%) obstetric anaesthesia, 164 (20%) inadequate anaesthesia, 95 (11%) dental damage, 71 (8%) airway (excluding dental damage), 63 (7%) drug related (excluding allergy), 31 (4%) drug allergy related, 31 (4%) positioning, 29 (3%) respiratory, 26 (3%) consent, 21 (2%) central venous cannulation and 18 (2%) peripheral venous cannulation. Defining which cases are, from a medico-legal viewpoint, 'high risk' is uncertain, but the clinical categories with the largest number of claims were regional anaesthesia, obstetric anaesthesia, inadequate anaesthesia, dental damage and airway, those with the highest overall cost were regional anaesthesia, obstetric anaesthesia, and airway and those with the highest mean cost per closed claim were respiratory, central venous cannulation and drug error excluding allergy. The data currently available have limitations but offer useful information. A closed claims analysis similar to that in the USA would improve the clinical usefulness of analysis.

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Analysis of Deaths Related to Anesthesia in the Period 1996–2004 from Closed Claims Registered by the Danish Patient Insurance Association

Abstract: Several of the 24 deaths could potentially have been avoided by more extended use of airway algorithm, thorough preoperative evaluation, training, education, and use of protocols for diagnosis and treatment.

Cited by 109 publications

References 9 publications

Valor dos achados clínicos e da avaliação funcional pulmonar pré-operatórios como preditores das complicações pulmonares pós-operatórias

Valor dos achados clínicos e da avaliação funcional pulmonar pré-operatórios como preditores das complicações pulmonares pós-operatórias

Treatment with Epinephrine (Adrenaline) in Suspected Anaphylaxis during Anesthesia in Denmark

Litigation related to anaesthesia: an analysis of claims against the NHS in England 1995–2007

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