Anesthesia- and opioids-related malpractice claims following tonsillectomy in USA: LexisNexis claims database 1984-2012

• Published in: Pediatric anesthesia Vol. 24; no. 4; pp. 412 - 420
• Main Authors: Subramanyam, Rajeev, Chidambaran, Vidya, Ding, Lili, Myer III, Charles M., Sadhasivam, Senthilkumar
• Format: Journal Article
• Language: English
• Published: France Blackwell Publishing Ltd 01-04-2014; Wiley Subscription Services, Inc
• Subjects: Adolescent; Adult; Analgesics, Opioid - adverse effects; anesthesia; Anesthesia - adverse effects; Child; Child, Preschool; complications; Databases, Factual; Female; Humans; Infant; Intraoperative Complications - epidemiology; Intraoperative Complications - mortality; Male; malpractice; Malpractice - statistics & numerical data; Middle Aged; opioids; Postoperative Complications - epidemiology; Postoperative Complications - mortality; tonsillectomy; Tonsillectomy - adverse effects; Tonsillectomy - legislation & jurisprudence; Tonsillectomy - mortality; United States - epidemiology; Young Adult; United States; database; tonsillectomy; complications; anesthesia; malpractice; opioids
• ISSN: 1155-5645; 1460-9592
• DOI: 10.1111/pan.12342

Summary
Background
Although commonly performed, tonsillectomy is not necessarily a low‐risk procedure for litigation. We have reviewed malpractice claims involving fatal and nonfatal injuries following tonsillectomy with an emphasis on anesthesia‐ and opioid‐related claims and their characteristics.
Methods
Tonsillectomy‐related malpractice claims and jury verdict reports from the United States (US) between 1984 and 2012 found in the LexisNexis MEGA™ Jury Verdicts and Settlements database were reviewed by two independent reviewers. LexisNexis database collects nationwide surgical, anesthesia, and other malpractice claims. Data including years of case and verdicts, surgical, anesthetic and postoperative opioid‐related complications, details of injury, death, cause of death, litigation result, and judgment awarded were analyzed. When there were discrepancies between the two independent reviewers, a third reviewer (SS) was involved for resolution. Inflation adjusted monetary awards were based on 2013 US dollars.
Results
There were 242 tonsillectomy‐related claim reports of which 98 were fatal claims (40.5%) and 144 nonfatal injury claims (59.5%). Verdict/settlement information was available in 72% of cases (n = 175). The median age group of patients was 8.5 years (range 9 months to 60 years). Primary causes for fatal claims were related to surgical factors (n = 39/98, 39.8%) followed by anesthesia‐related (n = 36/98, 36.7%) and opioid‐related factors (n = 16/98, 16.3%). Nonfatal injury claims were related to surgical (101/144, 70.1%), anesthesia (32/144, 22.2%)‐ and opioid‐related factors (6/144, 4.2%). Sleep apnea was recorded in 17 fatal (17.4%) and 15 nonfatal claims (10.4%). Opioid‐related claims had the largest median monetary awards for both fatal ($1 625 892) and nonfatal injury ($3 484 278) claims.
Conclusions
Tonsillectomy carries a high risk from a medical malpractice standpoint for the anesthesiologists and otolaryngologists. Although surgery‐related claims were more common, opioids‐ and anesthetic‐related claims were associated with larger median monetary verdicts, especially those associated with anoxic, nonfatal injuries. Caution is necessary when opioids are prescribed post‐tonsillectomy, especially in patients with sleep apnea.