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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