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.

The profile of anesthesia liability changed over the decades, including the types of anesthesia care associated with claims as well as events and injuries leading to claims. The most common complications in 1990-2007 were death, nerve injury and permanent brain damage. The most common anesthesia-related events leading to claims were regional-block related, respiratory, cardiovascular and equipment-related. This review includes focus on liability related to the difficult airway, monitored anesthesia care, non-operating room locations, obstetric anesthesia, and chronic pain management.

This analysis of claims arising from complications after peripheral IV and arterial vascular cannulation found that IV catheters were an important source of liability for anesthesiologists. IV claims involved a larger proportion of cardiac surgery procedures during which arms were tucked. Approximately half of IV claims resulted from extravasation of drugs or fluids. Claims related to radial arterial catheterization were uncommon.

The significant decrease in the proportion of claims for death or permanent brain damage from 1975 through 2000 seems to be unrelated to a marked increase in the proportion of claims where pulse oximetry and end-tidal carbon dioxide monitoring were used. After the introduction and use of these monitors, there was a significant reduction in the proportion of respiratory and an increase in the proportion of cardiovascular damaging events responsible for death or permanent brain damage.