United States: Chronic Pain Management (American Society of Anesthesiologists’ Closed Claims Project)

 

Claims

No.

%

Invasive procedures

276

97

 Injections

138

49

  Epidural steroids ± associated agents

114
 
  Trigger point

17
 
  Facet

4
 
  Other

3
 
 Blocks

78

27

  Peripheral

28
 
  Stellate ganglion

19
 
  Other autonomic

9
 
  Neuraxial

9
 
  Upper/lower extremity

7
 
  Axial

4
 
  Head and neck

2
 
 Ablative procedures

17

6

  Agent

13
 
  Technique

4
 
 Implantation or removal of devices

12

4

  Implantable pump

5
 
  Nerve stimulator

4
 
  Catheter

3
 
 Device maintenance

20

7

 Other interventionsa

11

4

Noninvasive pain management

8

3

 Medication prescription

5
 
 Opinion/diagnosis

2
 
 Cupping procedure

1
 

Source : Fitzgibbon et al. [1]. Reprinted from Anesthesiology. Used with permission from Lippincott Williams & Wilkins

Total does not sum to 100 % because of rounding

aIncludes three claims involving multiple procedures associated with complications. One of these claims involved invasive plus noninvasive pain management




Table 33.2
Primary outcome for invasive pain management claims























































































































































































































 
Injections (n = 138)
 
 
All invasive procedures (n = 276)

Blocks (n = 78)

Epidural steroid + agents (n = 114)

Trigger facet other (n = 24)

Ablative (n = 17)

Implant/removal (n = 12)

Maintenance (n = 20)

Other/multiple (n = 11)

Outcome

No.

%

No.

%

No.

%

No.

%

No.

%

No.

%

No.

%

No.

%

Nerve injury

63

23

14

18

28

25

2

8

8

47

2

17

4

20

5

45

Pneumothorax

59

21

40

51

0

0

18

75

1

6

0

0

0

0

0

0

Infection

35

13

2

3

24

21

0

0

0

0

3

25

4

20

2

18

Death/brain damage

26

9

4

5

9

8

0

0

1

6

0

0

9

45

3

27

Headache

21

8

1

1

20

18

0

0

0

0

0

0

0

0

0

0

Increased pain/no relief

21

8

7

9

10

9

0

0

0

0

2

17

1

5

1

9

Retained catheter

9

3

1

1

4

4

1

4

0

0

3

25

0

0

0

0

None

7

3

1

1

4

4

0

0

1

6

1

8

0

0

0

0

Other

42

15

8

10

18

16

3

13

6

35

1

8

4

20

2

18


Source : Fitzgibbon et al. [1]. Reprinted from Anesthesiology. Used with permission from Lippincott Williams & Wilkins

Epidural injection of steroids (±local anesthetic and opioids) and injections, including trigger point, facet, and others, are listed separately, with percentage shown for each separate category. Otherwise, the percentage of claims implies the percentage in each invasive procedure group. Totals sum to more than 100 % because of multiple complications in some claims



Table 33.3
Payment, standard of care, and prevention: chronic pain management versus other claims






















































































 
Chronic pain (n = 284)

Surgical/obstetric (n = 5125)
 

No.

%

No.

%

P

Payment made to plaintiff

142

53

2777

59

NS

No payment

126

47

1891

41

NS

Standard care

155

65

2501

56

≤0.01

Substandard care

84

35

1934

44

≤0.01

Injury became apparent in anesthesia facility

71

36

2166

83

≤0.01

Injury became apparent after discharge

127

64

443

17

≤0.01

Complication preventable by better preanesthetic evaluation

15

7

395

9

NS

Not preventable by better preanesthetic evaluation

213

93

4080

91

NS

Complication preventable by better postanesthetic care

26

12

431

11

NS

Not preventable by better postanesthetic care

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Oct 25, 2017 | Posted by in Uncategorized | Comments Off on United States: Chronic Pain Management (American Society of Anesthesiologists’ Closed Claims Project)

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