title: Analysis of patient injury based on anesthesiology closed claims data from a major malpractice insurer.
abstract: BACKGROUND
  The analysis of malpractice claims can provide risk managers with a detailed view of patient mortality and morbidity. The data comes from many institutions, encompasses a diverse group of practitioners and practice settings, and contains detailed clinical information. Analysis can help identify patterns of injury, risk factors, and rare and sentinel events.
  
  
  METHODS
  We examined most recent anesthesia closed claims data collected by The Doctors Company, a large national malpractice insurer. We analyzed data from claims closed between 2007 and 2012. Each claim underwent a review by physician and nurse experts, and was then coded using the Comprehensive Risk Intelligence Tool. Injury distribution and association between the injury and patient comorbidity were also examined.
  
  
  RESULTS
  A total of 607 claims were analyzed. Most frequent injuries were teeth damage (20.8%), death (18.3%), nerve damage (13.5%), organ damage (12.7%), pain (10.9%), and arrest (10.7%). Obesity was most frequently identified as a contributing factor leading to a claim. Injury-to-claim rates were highest in hospitals with fewer than 100 beds, while ambulatory surgery centers had the lowest death-to-claim rate (12%). Average indemnity for an anesthesia claim was $309 066, compared to $291 000 for all physician specialties.
  
  
  CONCLUSIONS
  The most frequent claims were death and nerve damage when teeth damage was excluded. Obesity impacted anesthesia outcomes more frequently than did other comorbidities. Although there were fewer claims from the smaller hospitals, those claims had higher rates of mortality and nerve damage compared to larger-size hospitals. Further analysis is needed to evaluate these trends as well as impact of specific patient comorbidities on anesthesia outcomes.
authors.affiliation: The Doctors Company, Northeast region.
authors.forename: Darrell
authors.initials: D
authors.lastname: Ranum
authors.forename: Haobo
authors.initials: H
authors.lastname: Ma
authors.forename: Fred E
authors.initials: FE
authors.lastname: Shapiro
authors.forename: Beverly
authors.initials: B
authors.lastname: Chang
authors.forename: Richard D
authors.initials: RD
authors.lastname: Urman
mesh_terms: D000776:Anesthesiology / Q000191:economics*; D006801:Humans; D007345:Insurance Claim Review; D007351:Insurance, Liability / Q000191:economics*; D008318:Malpractice / Q000191:economics*; D019300:Medical Errors / Q000191:economics*; D018570:Risk Assessment; D014481:United States