Insurance statements related to regional anaesthesia: A French database analysis

• Published in: Anaesthesia critical care & pain medicine 2016-10, Vol.35 (5), p.323-329
• Main Authors: Boutonnet, Mathieu, Trouiller, Pierre, Lopard, Eric, Amalberti, René, Houselstein, Thierry, Pasquier, Pierre, Auroy, Yves, De Saint Maurice, Guillaume
• Format: Article
• Language: English
• Subjects: Adult; Aged; Anaesthetic risk; Anesthesia & Perioperative Care; Anesthesia, Conduction - adverse effects; Anesthesiology - legislation & jurisprudence; Claims; Databases, Factual; Female; France; Humans; Insurance Carriers - statistics & numerical data; Insurance Claim Review; Insurance database; Intraoperative Complications - epidemiology; Liability; Liability, Legal; Male; Middle Aged; Perioperative medicine; Peripheral Nerve Injuries - epidemiology; Peripheral Nerve Injuries - etiology; Postoperative Complications - epidemiology; Regional anaesthesia; Retrospective Studies; Risk Assessment; Treatment Outcome
• ISSN: 2352-5568; 2352-5568
• DOI: 10.1016/j.accpm.2016.07.001

Abstract Background Adverse events in the perioperative period remain frequent, occurring in about 30% of the hospital admission and may be avoidable in nearly 50% of cases. Improving safety needs a continuous assessment of the risk level. Material and methods Data from the MACSF-Sou medical insurance company, including all the statements declared by anaesthesiologists and intensivists, were analyzed retrospectively by three experts, senior anaesthesiologists, of the SFAR, the French society of anesthesia and intensive care ( Société française d’anesthésie réanimation ) to describe the risk associated with regional anaesthesia. Results One hundred and sixty-four events were analyzed, involving young patients (mean age of 48.3 ± 15 years; sex ratio: 0.57). The most involved surgical specialties were: orthopaedic surgery (61%) and obstetric surgery (13.4%). Reported events were predominantly peripheral nerve injury (64.6%). Mechanical complications of puncture (pneumothorax, haemothorax, complications of axial punctures) accounted for approximately 15% of events, infection for 11%. The revelation was predominant in the postoperative course (137 cases, 83.6%), particularly after the release of the operating room in over 47% of cases, including 39 cases (22%) after discharge from the hospital. Conclusion Collaboration with insurance companies allows a relevant approach of the perioperative risk. In most cases, liability related to regional anaesthesia involved young patients in the perioperative course of scheduled surgery. One of the future challenges in managing, the anaesthetic and perioperative risks should be to invest more accurately the postoperative care both in the hospital or ambulatory settings.