title: Insurance statements from French anaesthesiologists and intensivists: A database analysis.
abstract: BACKGROUND
  From its origins, anaesthesia is a leading medical specialty for improving patient safety. However, perioperative adverse events remain frequent and may be preventable in 50% of cases. We conducted a collaborative retrospective study analysis of the insurance-database of the MACSF-Sou Medical insurance company to assess the perioperative risk.
  
  
  METHODS
  Retrospective study, including all the statements declared by anaesthesiologists to the MACSF-Sou Medical insurance company. A description of risk in perioperative medicine was performed by the assessment of these statements by three experts member of the SFAR. All the statements concerning regional anaesthesia and dental injuries were excluded.
  
  
  RESULTS
  Eight hundred and seventy statements were analyzed. The patients involved were predominantly women (sex-ratio: 0.86), with a mean age of 56 years (±18). Three hundred and fifteen cardiac arrests, 157 severe systemic complications, 340 moderate complications and 106 conflicts were analyzed. Most of the events were revealed postoperatively (79.3%) and almost half of them after the discharge of the postanesthetic care unit. The medical consequences were considered as serious. Death followed 35.9% of the events declared. Relative or true hypovolaemia and stroke were responsible for a large part of postoperative mortality and morbidity.
  
  
  CONCLUSIONS
  Collaborating with insurance companies allows a relevant approach of the perioperative risk. The study highlighted the importance of the delayed complications and is a plea for a more intense implication of anaesthesia in the postoperative care with the aim of improving patient safety.
authors.affiliation: Department of anaesthesiology and intensive care unit, Percy military teaching hospital, 101, avenue Henri-Barbusse, 92140 Clamart, France. Electronic address: mathieu.boutonnet.pro@gmail.com.
authors.forename: Mathieu
authors.initials: M
authors.lastname: Boutonnet
authors.affiliation: Intensive care unit, Antoine-Béclère university hospital, 157, rue de la Porte-de-Trivaux, Clamart, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Trouiller
authors.affiliation: MACSF-Le Sou Médical, 10, cours du Triangle-de-l'Arche, 92919 La Défense cedex, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Lopard
authors.affiliation: MACSF-Le Sou Médical, 10, cours du Triangle-de-l'Arche, 92919 La Défense cedex, France.
authors.forename: René
authors.initials: R
authors.lastname: Amalberti
authors.affiliation: MACSF-Le Sou Médical, 10, cours du Triangle-de-l'Arche, 92919 La Défense cedex, France.
authors.forename: Thierry
authors.initials: T
authors.lastname: Houselstein
authors.affiliation: Intensive care unit, Begin military teaching hospital, 69, avenue de Paris, Saint-Mandé, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Pasquier
authors.affiliation: Hospital and research division, head office of military health service, direction centrale du service de santé, Fort-Neuf de Vincennes, cours des Maréchaux, Vincennes, France.
authors.forename: Yves
authors.initials: Y
authors.lastname: Auroy
authors.affiliation: Department of anaesthesiology and intensive care unit, Val-de-Grâce military teaching hospital, 74, boulevard de Port-Royal, Paris, France.
authors.forename: Guillaume
authors.initials: G
authors.lastname: De Saint-Maurice
mesh_terms: D000328:Adult; D000368:Aged; D000758:Anesthesia / Q000009:adverse effects / Q000379:methods; D000072080:Anesthesiologists; D003422:Critical Care; D016208:Databases, Factual; D005260:Female; D005602:France; D006801:Humans; D007343:Insurance Carriers / Q000706:statistics & numerical data; D007345:Insurance Claim Review; D007431:Intraoperative Complications / Q000453:epidemiology; D016365:Liability, Legal; D008297:Male; D008875:Middle Aged; D061214:Patient Safety; D011183:Postoperative Complications / Q000453:epidemiology / Q000401:mortality; D012189:Retrospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome
keywords: Adverse events; Anaesthesia and intensive care; Insurance database; Liability; Perioperative medicine; Safety