This article reviews factors related to adverse events in relation to adult congenital heart disease (ACHD). Adults with ACHD are becoming a rapidly increasing proportion of the adult medical and surgical population. The authors reviewed closed medical malpractice claims from 1970 to 2001 from the Anesthesia Closed Claims Program. This article describes the contribution of perioperative risk factors to adverse outcomes as well as comparing contributing factors in cardiac versus non-cardiac operations. All cases were assessed separately for factors contributing to the adverse event and factors contributing to patient injury. Qualitative assessments are also presented and common themes across the cases reviewed.

This article reviews factors related to massive hemorrhage in surgical and obstetric patients. The authors reviewed closed anesthesia malpractice claims from 1995 to 2011 from the Anesthesia Closed Claims Program. Hemorrhage claims were compared to all other surgical and obstetric claims to identify recurrent patterns and medicolegal consequences. Although massive hemorrhage claims are a small proportion of surgical and obstetric claims (4%), a high percentage resulted in death or permanent injury. Compared to non-hemorrhage claims, obstetrics and thoracic or lumbar spine surgery were overrepresented, mortality was higher, care was more often judged less than appropriate, and claim payments were higher. Common risk factors and clinical problems were identified, including poor team communication, and lack of timely diagnosis, transfusion, and re-operation.

Claims for deaths with evaluable autopsies were compared with deaths without autopsy from 1990 and later taken from the ASA Closed Claims Program database. Autopsy findings were helpful for the defense in 55% and harmful in 27% of the claims against anesthesiologists. Two thirds of evaluable claims indentified a significant non-anesthetic contribution to death.

Twenty-one cases which involved adverse anesthetic outcome were reviewed by 112 practicing anesthesiologists who were asked to judge the standard of care. Matched sets of cases were judged which differed only in outcome. A significant inverse relationship was noted between severity of outcome and appropriateness of care. For the same clinical scenario, as the severity of patient injury increased care was more apt to be judged substandard.