Liability Associated with Obstetric Anesthesia A Closed Claims Analysis
Liability Associated with Obstetric Anesthesia A Closed Claims Analysis
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DOI：
10.1097/aln.0b013e318190e16a
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发表时间：
2009-01-01
期刊：
影响因子：
8.8
通讯作者：
Domino, Karen B.
中科院分区：
文献类型：
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作者：
Davies, Joanna M.;Posner, Karen L.;Domino, Karen B.
背景：产科具有很高的医疗责任风险。产妇死亡和新生儿死亡/脑损伤是1990年以前产科麻醉事故索赔中最常见的并发症。由于责任结构在过去20年中可能发生了变化，作者回顾了美国麻醉师协会封闭索赔数据库中最近的产科索赔。方法：将1990年至2003年的产科麻醉索赔(1990年或以后的索赔；n=426)与1990年之前的产科伤害索赔(n=190)进行比较。卡方检验和z检验比较分类变量；支付金额比较采用柯尔莫戈洛夫-斯米尔诺夫检验。结果：与1990年以前相比，1990年或以后产科索赔中孕产妇死亡(P=0.002)和新生儿死亡/脑损伤(P=0.048)的比例下降，而母亲神经损伤(P<；0.001)和母亲背痛(P=0.012)的比例上升。在1990年或以后的索赔中，只有21%的新生儿死亡/脑损伤索赔是以麻醉师的名义支付的，而产妇死亡/脑损伤索赔的比例是60%(P<；0.001)。在两组中，这些费用都与麻醉对伤害的贡献(P<；0.001)和不符合标准的麻醉护理(P<；0.001)相关。与麻醉无关的索赔相比，与麻醉相关的新生儿死亡/脑损伤索赔延迟(P=0.001)和沟通不畅(P=0.007)的比例增加。结论：新生儿死亡/脑损伤的索赔有所减少，但随着时间的推移，它仍然是产科麻醉事故索赔的主要原因。新生儿受伤的潜在麻醉原因包括麻醉护理的延迟以及产科医生和麻醉师之间沟通不畅。
Background: Obstetrics carries high medical liability risk. Maternal death and newborn death/brain damage were the most common complications in obstetric anesthesia malpractice claims before 1990. As the liability profile may have changed over the past two decades, the authors reviewed recent obstetric claims in the American Society of Anesthesiologist Closed Claims database.Methods: Obstetric anesthesia claims for injuries from 1990 to 2003 (1990 or later claims; n = 426) were compared to obstetric claims for injuries before 1990 (n = 190). Chi-square and z tests compared categorical variables; payment amounts were compared using the Kolmogorov-Smirnov test.Results: Compared to pre-1990 obstetric claims, the proportion of maternal death (P = 0.002) and newborn death/brain damage (P = 0.048) decreased, whereas maternal nerve injury (P < 0.001) and maternal back pain (P = 0.012) increased in 1990 or later claims. In 1990 or later claims, payment was made on behalf of the anesthesiologist in only 21% of newborn death/brain damage claims compared to 60% of maternal death/brain damage claims (P < 0.001). These payments in both groups were associated with an anesthesia contribution to the injury (P < 0.001) and substandard anesthesia care (P < 0.001). Anesthesia-related newborn death/brain damage claims had an increased proportion of delays in anesthetic care (P = 0.001) and poor communication (P = 0.007) compared to claims unrelated to anesthesia.Conclusion: Newborn death/brain damage has decreased, yet it remains a leading cause of obstetric anesthesia malpractice claims over time. Potentially preventable anesthetic causes of newborn injury included delays in anesthesia care and poor communication between the obstetrician and anesthesiologist.