title: Insurance statements related to regional anaesthesia: A French database analysis.
abstract: BACKGROUND
  Adverse events in the perioperative period remain frequent, occurring in about 30% of the hospital admission and may be avoidable in nearly 50% of cases. Improving safety needs a continuous assessment of the risk level.
  
  
  METHODS
  Data from the MACSF-Sou medical insurance company, including all the statements declared by anaesthesiologists and intensivists, were analyzed retrospectively by three experts, senior anaesthesiologists, of the SFAR, the French society of anesthesia and intensive care (Société française d'anesthésie réanimation) to describe the risk associated with regional anaesthesia.
  
  
  RESULTS
  One hundred and sixty-four events were analyzed, involving young patients (mean age of 48.3±15years; sex ratio: 0.57). The most involved surgical specialties were: orthopaedic surgery (61%) and obstetric surgery (13.4%). Reported events were predominantly peripheral nerve injury (64.6%). Mechanical complications of puncture (pneumothorax, haemothorax, complications of axial punctures) accounted for approximately 15% of events, infection for 11%. The revelation was predominant in the postoperative course (137 cases, 83.6%), particularly after the release of the operating room in over 47% of cases, including 39 cases (22%) after discharge from the hospital.
  
  
  CONCLUSIONS
  Collaboration with insurance companies allows a relevant approach of the perioperative risk. In most cases, liability related to regional anaesthesia involved young patients in the perioperative course of scheduled surgery. One of the future challenges in managing, the anaesthetic and perioperative risks should be to invest more accurately the postoperative care both in the hospital or ambulatory settings.
authors: 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: Mathieu
authors: M
authors: Boutonnet
authors: Intensive Care Unit, Antoine-Béclère University Hospital, 157, rue de la Porte de Trivaux, Clamart, France.
authors: Pierre
authors: P
authors: Trouiller
authors: MACSF-Le Sou Médical, 10, cours du Triangle de l'Arche, 92919 La Défense cedex, France.
authors: Eric
authors: E
authors: Lopard
authors: MACSF-Le Sou Médical, 10, cours du Triangle de l'Arche, 92919 La Défense cedex, France.
authors: René
authors: R
authors: Amalberti
authors: MACSF-Le Sou Médical, 10, cours du Triangle de l'Arche, 92919 La Défense cedex, France.
authors: Thierry
authors: T
authors: Houselstein
authors: Intensive care unit, Begin Military Teaching Hospital, 69, avenue de Paris, Saint-Mandé, France.
authors: Pierre
authors: P
authors: Pasquier
authors: 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: Yves
authors: Y
authors: Auroy
authors: Department of Anaesthesiology and Intensive Care Unit, Val-de-Grâce Military Teaching Hospital, 74, boulevard de Port Royal, Paris, France.
authors: Guillaume
authors: G
authors: De Saint Maurice
mesh_terms: D000328:Adult; D000368:Aged; D000765:Anesthesia, Conduction / Q000009:adverse effects*; D000776:Anesthesiology / Q000331:legislation & jurisprudence; 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; D059348:Peripheral Nerve Injuries / Q000453:epidemiology / Q000209:etiology; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome
keywords: Anaesthetic risk; Claims; Insurance database; Liability; Perioperative medicine; Regional anaesthesia