title: Serious complications associated with spinal and epidural anaesthesia in Finland from 2000 to 2009.
abstract: BACKGROUND
  Analyses of closed claims provide insight into the characteristics of rare complications. Serious complications related to spinal and epidural blocks are relatively rare. In Finland, all malpractice cases are primarily handled by the Patient Insurance Centre (PIC) within a 'no-fault scheme'.
  
  
  METHODS
  All claims attributed to central neuraxial blocks and settled by the PIC during the period, 2000-2009 were analysed. The number of spinal and epidural procedures performed during this time was estimated based on a questionnaire sent to all surgical hospitals in Finland in 2009, surveying the numbers and types of neuraxial blocks carried out in 2008.
  
  
  RESULTS
  During the study period, 216 closed claims were flagged with spinal or epidural blocks. In 41 of 216 instances, the neuraxial block was apparently responsible for a serious (fatal or critical or lasting >1 year) complication. These included six fatalities and 13 epidural haematomata (two in conjunction with fondaparinux, three with excessive doses of low molecular weight heparins, six where present guidelines were not observed). Fatalities occurred in 1 : 775,000 spinals for surgery, 1 : 62,000 in epidurals for surgery or acute pain relief, 1 : 12,000 epidurals for chronic pain relief, 1 : 89,000 in combined spinal and epidural for surgery, and 1 : 144,000 epidurals for labour. The incidence of neuraxial haematoma after spinal block was 1 : 775,000, that for epidural block 1 : 26,400, and in the case of combined spinal and epidural, 1 : 17,800. Irrespective of the method of neuraxial technique, the majority of patients suffering serious complications were the elderly having comorbidities.
  
  
  CONCLUSIONS
  In this closed claims analysis, major problems related to neuraxial blocks were rare. Epidural or a combined spinal and epidural technique resulted in more complications than did spinal procedure.
authors.affiliation: Department of Anaesthesia, Orthopaedic Hospital Orton, Invalid Foundation, Helsinki, Finland. mikko.pitkanen@orton.fi
authors.forename: M T
authors.initials: MT
authors.lastname: Pitkänen
authors.forename: U
authors.initials: U
authors.lastname: Aromaa
authors.forename: D A
authors.initials: DA
authors.lastname: Cozanitis
authors.forename: J G
authors.initials: JG
authors.lastname: Förster
mesh_terms: D000038:Abscess / Q000453:epidemiology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000767:Anesthesia, Epidural / Q000009:adverse effects*; D000775:Anesthesia, Spinal / Q000009:adverse effects*; D005260:Female; D005387:Finland / Q000453:epidemiology; D006406:Hematoma / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007239:Infections / Q000453:epidemiology; D008297:Male; D008318:Malpractice / Q000706:statistics & numerical data; D008581:Meningitis / Q000453:epidemiology; D008875:Middle Aged; D009026:Mortality; D010146:Pain / Q000453:epidemiology; D020335:Paraparesis / Q000453:epidemiology; D011795:Surveys and Questionnaires; D055815:Young Adult