Airway injury during anesthesia - A closed claims analysis

Background: Airway injury during general anesthesia is a significant source of morbidity for patients and a source of Liability for anesthesiologists. To identify recurrent patterns of injury, the authors analyzed claims for airway injury in the American Society of Anesthesiologists (ASA) Closed Cla ims Project database, Methods: The ASA Closed Claims database is a standardized collection of cas e summaries derived horn professional liability insurance companies closed claims files. All claims for airway injury were reviewed in depth and were compared to other claims during general anesthesia. Results: Approximately 6% (266) of 4,460 claims in the database were for ai rway injury. The most frequent sites of injury were the larynx (33%), phary nx (19%), and esophagus (18%), Injuries to the esophagus and trachea were m ore frequently associated with difficult intubation. Injuries to temporoman dibular joint and the larynx were more frequently associated with nondiffic ult intubation, Injuries to the esophagus were more severe and resulted in a higher payment to the plaintiff than claims for other sites of aim ay inj ury. Difficult intubation (odds ratio = 4.53, 95% confidence interval [CI] = 2.36, 8.71), age older than 60 yr (odds ratio = 2.97, 95% CI = 1.51, 5.87 ), and female Sender (odds ratio = 2.43, 95% CI = 1.09, 5.42) were associat ed with claims for pharyngoesophageal perforation. Early signs of perforati on, e.g., pneumothorax and subcutaneous emphysema, were present in only 51% of perforation claims, whereas late sequelae, e.g., retropharyngeal absces s and mediastinitis, occurred in 65%. Conclusion Patients in whom tracheal intubation has been difficult should b e observed for and told to watch for the development of symptoms and signs of retropharyngeal abscess, mediastinitis, or both.