Purpose

To evaluate the types of anesthesia-related closed claims and their contributing factors, using data from the Ophthalmic Mutual Insurance Company (OMIC).

Design

Retrospective analysis of preexisting data.

Participants

Plaintiffs who filed a professional liability claim or suit (written demand for money) against OMIC-insured ophthalmologists, ophthalmic practices, or surgicenters in which the surgical case occurred.

Methods

Plaintiff claims were collected from the OMIC database from 2008 to 2018 using search queries for terms associated with known complications of ophthalmic anesthesia.

Main Outcome Measures

Number and types of anesthesia-related injuries and claims, who administered the anesthesia, the outcomes of the claim or suit, cost to defend, and payments made to plaintiffs.

Results

Sixty-three anesthesia-related claims or suits were filed by 50 plaintiffs. Anesthesia-related injuries included globe perforation (n = 17), death (n = 13), retrobulbar hemorrhage (n = 7), optic nerve damage (n = 4), vascular occlusions (n = 2), pain (n = 2), eye or head movement resulting in injury (n = 2), and 1 case each for numbness, diplopia, and tooth loss during intubation. All but 1 patient who died had preexisting, significant comorbidities. Two deaths were related to brainstem anesthesia. Regarding the type of anesthesia in the closed claims, retrobulbar and peribulbar anesthesia were the most common types (n = 16 each), followed by local infiltration around the lids and facial nerve (n = 6), topical anesthesia (n = 5), and general anesthesia (n = 5). In 2 cases, the exact type of anesthesia was unknown but not general. The 5 topical with sedation anesthesia-related claims were due to inadequate pain control (n = 2), ocular movement resulting in capsular rupture (n = 2), or death (n = 1) allegedly related to excessive or inadequate monitoring of sedation. There were 5 claims related to general anesthesia including 4 deaths and 1 tooth loss during intubation. Sedation was alleged to be a factor in 5 cases resulting in death. Anticoagulants were a factor in 3 retrobulbar hemorrhage cases.

Conclusions

Although claims and suits were infrequent given the large number of insured ophthalmologists and the large number of surgical cases requiring various types of anesthesia performed over the 10.5-year study period, severe injuries can occur.

中文翻译：

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Ophthalmic Mutual Insurance Company 2008-2018 眼部麻醉相关已结案索赔。

目的

使用眼科互助保险公司 (OMIC) 的数据评估与麻醉相关的已结索赔类型及其影响因素。

设计

对预先存在的数据进行回顾性分析。

参与者

向 OMIC 保险的眼科医生、眼科诊所或发生手术病例的外科中心提出专业责任索赔或诉讼（书面要求金钱）的原告。

方法

原告索赔是在 2008 年至 2018 年期间使用与已知眼科麻醉并发症相关的术语的搜索查询从 OMIC 数据库中收集的。

主要观察指标

与麻醉相关的伤害和索赔的数量和类型、实施麻醉的人员、索赔或诉讼的结果、辩护费用以及支付给原告的款项。

结果

50 名原告提出了 63 项与麻醉相关的索赔或诉讼。麻醉相关损伤包括眼球穿孔 (n = 17)、死亡 (n = 13)、球后出血 (n = 7)、视神经损伤 (n = 4)、血管闭塞 (n = 2)、疼痛 (n = 2) )、眼睛或头部运动导致损伤 (n = 2)，插管期间麻木、复视和牙齿脱落各 1 例。除 1 名死亡患者外，所有患者均存在先前存在的显着合并症。两例死亡与脑干麻醉有关。关于封闭索赔中的麻醉类型，球后和球周麻醉是最常见的类型（n = 16），其次是眼睑和面神经周围的局部浸润（n = 6），局部麻醉（n = 5），和全身麻醉（n = 5）。在 2 例中，确切的麻醉类型未知，但并不普遍。5 起与镇静麻醉相关的局部索赔是由于疼痛控制不足 (n = 2)、眼球运动导致囊膜破裂 (n = 2) 或死亡 (n = 1) 据称与镇静监测过度或不足有关。有 5 项与全身麻醉相关的索赔，包括 4 例死亡和 1 例插管过程中的牙齿脱落。据称镇静是导致死亡的 5 起案件的一个因素。抗凝剂是 3 例球后出血病例的一个因素。据称镇静是导致死亡的 5 起案件的一个因素。抗凝剂是 3 例球后出血病例的一个因素。据称镇静是导致死亡的 5 起案件的一个因素。抗凝剂是 3 例球后出血病例的一个因素。

结论

尽管在 10.5 年的研究期内，由于有大量投保的眼科医生和大量需要进行各种类型麻醉的手术病例，索赔和诉讼并不常见，但仍可能发生严重伤害。