Characterization and analysis of adverse events in closed liability cases involving anaesthetists who received legal support from the Colombian Society of Anaesthesia and Resuscitation (S.C.A.R.E.), Colombia, 1993–2012

Abstract

IntroductionAdverse events are the source of significant care-related morbidity and mortality in surgical patients. ObjectiveTo characterize and analyze anaesthesia-related adverse events in closed ethical and legal cases, with the involvement of the Colombian Society of Anaesthesia and Resuscitation (Sociedad Colombiana de Anestesiología y Reanimación – S.C.A.R.E.) between 1993 and 2012. Materials and methodsRetrospective analysis of medical liability cases involving anaesthetists, managed with the support of the Special Fund for Mutual Legal Assistance (FEPASDE). ResultsOverall, 278 proceedings involving anaesthesia-related adverse events were analyzed. The majority (67%) occurred in association with planned surgical procedures (general surgery, orthopaedic surgery, plastic surgery, and obstetrics and gynaecology) performed under general anaesthesia in ASA I patients taken to surgery in Level II complexity settings. A substantial percentage of adverse events (18%) occurred in the Post-Anaesthetic Care Unit (PACU). The most frequent adverse events were cardiovascular and respiratory (55.4% and 36.7% respectively). The most predominant outcomes were death (50.3%) and cerebral insult (22.3%). The analysis found flaws in the completion of the pre-anaesthetic assessment and informed consent forms, compliance with guidelines, standards or protocols, communication with the patient or the family after the event, and communication among the members of the healthcare team. ConclusionsIn the cases reviewed, the majority of adverse events happened in low risk patients, in low complexity institutions. The PACU was a sensitive setting for the occurrence of adverse events. It is important to consider environmental factors when analysing adverse events.