• Elke M E Bos, Karen L Posner, Karen B Domino, Marcel de Quelerij, Cor J Kalkman, Markus W Hollmann, and Philipp Lirk.
• From the Department of Anaesthesiology, Amsterdam UMC, location Academic Medical Centre, Amsterdam, the Netherlands (EMEB, MWH), Department of Anaesthesiology and Pain Medicine, University of Washington, Seattle, Washington (KLP, KBD), Department of Anaesthesiology, Franciscus Gasthuis and Vlietland, Rotterdam, the Netherlands (MdQ), Division of Anaesthesiology, Intensive Care and Emergency Medicine, University Medical Centre, Utrecht, the Netherlands (CJK) and Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA (PL).
• Eur J Anaesthesiol. 2020 Sep 1; 37 (9): 743-751.

BackgroundSevere complications after neuraxial anaesthesia are rare but potentially devastating.ObjectiveWe aimed to identify characteristics and preventable causes of haematoma, abscess or meningitis after neuraxial anaesthesia.DesignObservational study, closed claims analysis.SettingClosed anaesthesia malpractice claims from the USA and the Netherlands were examined from 2007 until 2017.PatientsClaims of patients with haematoma (n = 41), abscess (n = 18) or meningitis (n = 14) associated with neuraxial anaesthesia for labour, acute and chronic pain that initiated and closed between 2007 and 2017 were included. There were no exclusions.Main Outcome MeasuresWe analysed potential preventable causes in patient-related, neuraxial procedure-related, treatment-related and legal characteristics of these complications.ResultsPatients experiencing spinal haematoma were predominantly above 60 years of age and using antihaemostatic medication, whereas patients with abscess or meningitis were middle-aged, relatively healthy and more often involved in emergency interventions. Potential preventable causes of unfavourable sequelae constituted errors in timing/prescription of antihaemostatic medication (10 claims, 14%), unsterile procedures (n = 10, 14%) and delay in diagnosis/treatment of the complication (n = 18, 25%). The number of claims resulting in payment was similar between countries (USA n = 15, 38% vs. the Netherlands n = 17, 52%; P = 0.25). The median indemnity payment, which the patient received varied widely between the USA (&OV0556;285 488, n = 14) and the Netherlands (&OV0556;31 031, n = 17) (P = 0.004). However, the considerable differences in legal systems and administration of expenses between countries may make meaningful comparison of indemnity payments inappropriate.ConclusionsClaims of spinal haematoma were often related to errors in antihaemostatic medication and delay in diagnosis and/or treatment. Spinal abscess claims were related to emergency interventions and lack of sterility. We wish to highlight these potential preventable causes, both when performing the neuraxial procedure and during postprocedural care of patients.

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