Medicolegal Considerations in Urologic Anesthesia

  • Elizabeth A. M. Frost


Extreme position changes, electrolyte changes, presence of comorbidities such as obstructive sleep apnea, long and complex surgeries, bleeding risks, and an elderly population combine together to increase the risk of perioperative complications during urologic procedures. Not uncommonly these complications may be rightly or wrongly interpreted as malpractice, and the case becomes entrenched in the medicolegal system. Understanding this system and developing strategies to avoid poor or even catastrophic outcomes are essential to the entire urologic team.


Obstructive Sleep Apnea Compartment Syndrome Medical Malpractice Malpractice Claim Anesthetic Care 
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  1. 1.
    Prince JD. The code of Hammurabi, a review. Am J Theol. 1904;8(3):601–9. Publis Scholar
  2. 2.
    Jena AB, Seabury S, Lakdawalla D, et al. Malpractice risk according to physician specialty. N Engl J Med. 2011;365(7):629–36.PubMedCrossRefGoogle Scholar
  3. 3.
    Szypula K, Ashpole KJ, Bogo D, et al. Litigation related to regional anaesthesia: an analysis of claims against the NHS in England 1995–2007. Anaesthesia. 2010;65(5):443–52.PubMedCrossRefGoogle Scholar
  4. 4.
    Staender S, Schaer H, Clerque F, et al. A Swiss anaesthesiology closed claims analysis: report of events in the years 1987–2008. Eur J Anaesthesiol. 2011;28(2):85–91.PubMedCrossRefGoogle Scholar
  5. 5.
    Benson JS, Coogan CL. Urologic malpractice: analysis of indemnity and claim data from 1985–2007. J Urol. 2010;184(3):1086–90.PubMedCrossRefGoogle Scholar
  6. 6.
    Cheney FW, Posner KL, Lee LA, et al. Trends in anesthesia –related death and brain damage: a closed claims analysis. Anesthesiology. 2006;105(6):1081–6.PubMedCrossRefGoogle Scholar
  7. 7.
    Chandra A, Nundy S, Seabury SA. The growth of physician medical malpractice payments; evidence from the National Practitioner Data Bank. Health Aff (Millwood). 2005 Jan–Jun; Suppl Web exclusives: W5-240-W5-249. Accessed 20 Dec 2011.Google Scholar
  8. 8.
    Tung A, Roth S. Anesthesia malpractice in a litigious area: a closed claims study in an academic medical center. ASA abstracts A 194. Atlanta 13 Oct 2007.Google Scholar
  9. 9.
    Robbertze R, Posner KL, Domino KB. Closed claims review of anesthesia for procedures outside the operating room. Curr Opin Anaesthesiol. 2006;19(4):436–42.PubMedCrossRefGoogle Scholar
  10. 10.
    Bhananaker SM, Posner KL, Cheney FW, et al. Injury and liability associated with monitored anesthesia care: a closed claims analysis. Anesthesiology. 2006;104(2):228–34.CrossRefGoogle Scholar
  11. 11.
    Fugaro L. Anesthesia medical malpractice is often devastating and deadly
  12. 12.
    Feldman JM. Do anesthesia information systems increase malpractice errors? Results of a survey. Anesth Analg. 2004;99(3):840–3.PubMedCrossRefGoogle Scholar
  13. 13.
    Bloomfield EL, Feinglass NG. The anesthesia information management system for electronic documentation: what are we waiting for? J Anesth. 2008;2294:404–11.CrossRefGoogle Scholar
  14. 14.
    Vigoda MM, Lubarsky DA. The medicolegal importance of enhancing timeliness of documentation when using an anesthesia information system and the response to automated feedback in an academic practice. Anesth Analg. 2006;10391:131–6.CrossRefGoogle Scholar
  15. 15.
    Kachalia A, Kaufman SR, Boothman R, et al. Liability claims and costs before and after implementation of a medical error disclosure program. Ann Intern Med. 2010;153(4):213–21.PubMedCrossRefGoogle Scholar
  16. 16.
    Ghalandarpoorattar SM, Kaviani A, Asghari F. Medical error disclosure: the gap between attitude and practice. Postgrad Med J. 2012;88(1037):130–3.PubMedCrossRefGoogle Scholar
  17. 17.
    Caplan RA. Closed claims; medical mistakes audio digest. Anesthesiology 2010; 52(5) 7 Mar 2010.Google Scholar
  18. 18. Guidelines for expert witness testimony. Accessed 22 Feb 2012.
  19. 19.
    University of Washington Medical Center. The anesthesia closed claims project. Accessed 22 Feb 2012.
  20. 20.
    Metzner J, Posner KL, Lam MS, Domino KB. Closed claims analysis. Best Pract Res Clin Anaesthesiol. 2011;25(2):263–76.PubMedCrossRefGoogle Scholar
  21. 21.
    Morray JP, Geiduschek JM, Ramamoorthy C, et al. Anesthesia-related cardiac arrest in children: initial findings of the pediatric perioperative cardiac arrest (POCA) registry. Anesthesiology. 2000;93:6–14.PubMedCrossRefGoogle Scholar
  22. 22.
    Bhananker SM, Ramamoorthy C, Geiduschek JM, et al. Anesthesia related cardiac arrest in children: update from the pediatric perioperative cardiac arrest registry. Anesth Analg. 2007;105(2):335–43.CrossRefGoogle Scholar
  23. 23.
    Berg KT, Harrison AR, Lee MS. Perioperative visual loss in ocular and nonocular surgery. Clin Ophthalmol. 2010;4:531–46.PubMedGoogle Scholar
  24. 24.
    Postoperative Visual Loss Study Group with 39 Collaborators. Risk factors associated with ischemic optic neuropathy after spinal fusion surgery. Anesthesiology. 2012;118(1):15–24.Google Scholar
  25. 25.
    Kent CD, Domino KB. Awareness: practice, standards, and the law. Best Pract Res Clin Anaesthesiol. 2007;21(3):369–83.PubMedCrossRefGoogle Scholar
  26. 26.
    Domino KB, Posner KL, Caplan RA, Cheney FW. Awareness during anesthesia: a closed claims analysis. Anesthesiology. 1999;90:1053–61.PubMedCrossRefGoogle Scholar
  27. 27.
    Lee L. APSF funds new registry: the neurologic injury after non-supine shoulder surgery (NINSS) registry. APSF Newsletter Spring. 2010;25(1):1–3.Google Scholar
  28. 28.
    Domino KB, Caplan RA, Lee LA. ASA closed claims project and its registries value to patients and pocketbook ASA refresher course 222 Oct 2010, San Diego.Google Scholar
  29. 29.
    Lee LA, Stephens LS, Fligner CL, Posner KL, Cheney FW, Caplan RA, Domino KB. Autopsy utilization in medicolegal defense of anesthesiologists. Anesthesiology. 2011;115(4):713–7.PubMedCrossRefGoogle Scholar
  30. 30.
    ASA Task Force on Preanesthesia Evaluation. Practice advisory for preanesthesia evaluation. Anesthesiology. 2012;116(3):1–17.Google Scholar
  31. 31.
    Ellingson K, Seem D, Nowicki M, Strong DM, Kuehnert MJ, Organ Procurement Organization Nucleic Acid Testing Yield Project Team. Estimated risk of human immunodeficiency virus and hepatitis C virus infection among potential organ donors from 17 organ procurement organizations in the United States. Am J Transplant. 2011;11:1201–8.PubMedCrossRefGoogle Scholar
  32. 32.
    Kleinman SH, Lelie N, Busch MP. Infectivity of human immunodeficiency virus-1, hepatitis C virus, and hepatitis B virus and risk of transmission by transfusion. Transfusion. 2009;49:2454–89.PubMedCrossRefGoogle Scholar
  33. 33.
    Draft PHS. Guideline for reducing transmission of human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV) through solid organ transplantation. Available at Enter: ID = CDC-2011-0011. Accessed 23 Feb 2012.
  34. 34.
    Akhavan A, Gainsburg DM, Stock JA. Complications associated with patient positioning in urologic surgery. Urology. 2010;76(6):1309–16.PubMedCrossRefGoogle Scholar
  35. 35.
    Anusionwu IM, Wright EJ. Compartment syndrome after positioning in lithotomy: what a urologist needs to know. BJU Int. 2011;108(40):477–8.PubMedCrossRefGoogle Scholar
  36. 36.
    Simms MS, Terry TR. Well leg compartment syndrome after pelvic and perineal surgery in the lithotomy position. Postgrad Med J. 2005;81:534–6.PubMedCrossRefGoogle Scholar
  37. 37.
    Szalay G, Meyer C, Alt V, et al. Acute compartment syndrome of the lower leg as an interdisciplinary complication after long duration intervention in the lithotomy position. Zentralbt Chir. 2010;135(2):163–7.CrossRefGoogle Scholar
  38. 38.
    American Society of Anesthesiologists Task Force of Perioperative Blindness. Practice advisory for perioperative visual loss associated with spine surgery: a report by the American Society of Anesthesiologists Task Force on Perioperative Blindness. Anesthesiology. 2006;104:1319–28.CrossRefGoogle Scholar
  39. 39.
    Postoperative visual study group. Risk factors associated with ischemic optic neuropathy after spinal fusion surgery. Anesthesiology. 2012;116(1):15–24.Google Scholar
  40. 40.
    Weber ED. Posterior ischemic optic neuropathy after minimally invasive prostatectomy. J Neuroophthalmol. 2007;27(4):285–7.PubMedCrossRefGoogle Scholar
  41. 41.
    Groeben HT, Killic O, Boergers A et al. Lung function and upper airway resistance following robotic radical prostatectomy ASA annual meeting Abstract A1154 17 Oct 2011, Chicago.Google Scholar
  42. 42.
    Groeben HT, Killic O, Boergers A et al. Lung function and upper airway resistance following robotic radical prostatectomy in patients with and without COPDASA annual meeting Abstract A1152, 17 Oct 2011, Chicago.Google Scholar
  43. 43.
    Chappell D, Jacob M, Hofmann-Kiefer K, et al. A rational approach to perioperative fluid management. Anesthesiology. 2008;109(4):723–40.PubMedCrossRefGoogle Scholar
  44. 44.
    Hughes CG, Weavind L, Banerjee A, et al. Intraoperative risk factors for acute respiratory distress syndrome in critically ill patients. Anesth Analg. 2010;111(2):464–7.PubMedCrossRefGoogle Scholar
  45. 45.
    Benes J, Chytra I, Altmann P, et al. Intraoperative fluid optimization using stroke volume variation in high risk surgical patients: results of prospective randomized study. Crit Care. 2010;14(3):R118.PubMedCrossRefGoogle Scholar
  46. 46.
    Forget P, Lois F, de Kock M. Goal directed fluid management based on the pulse oximeter-derived pleth variability index reduces lactate levels and improves fluid management. Anesth Analg. 2010;111(4):910–4.PubMedGoogle Scholar
  47. 47.
    Jain AK, Dutta A. Stroke volume variation as a guide to fluid administration in morbidly obese patients undergoing laparoscopic bariatric surgery. Obes Surg. 2010;20(6):709–15.PubMedCrossRefGoogle Scholar
  48. 48.
    Kressin KA, Posner KL, Lee LA et al. Burn injury in the OR: a closed claims analysis. Anesthesiology. 2004;101:A-1282.Google Scholar
  49. 49.
    Yardley IE, Donaldson LJ. Surgical fires, a clear and present danger. Surgeon. 2010;8(2):87–92.PubMedCrossRefGoogle Scholar
  50. 50.
    Practice advisory for the prevention and management of Operating room Fires a report by the American Society of Anesthesiologists task force on operating room fires. Anesthesiology. 2008;108:786–801.Google Scholar
  51. 51.
    Rinder CS. Fire safety in the operating room. Curr Opin Anaesthesiol. 2008;21(6):790–5.PubMedCrossRefGoogle Scholar
  52. 52.
    Jimenez N. Trends on pediatric anesthesia malpractice claims over the last three decades. ASA Newsl. 2005;69(6):8–9. 12.Google Scholar
  53. 53.
    Jimenez N, Posner K, Cheney FW. An update on pediatric anesthesia liability: a closed claims analysis. Anesth Analg. 2007;105:344–50.CrossRefGoogle Scholar
  54. 54.
    Kaddooun RN, Chidiac EJ, Zestos MM, et al. Electrocautery-induced fire during adenotonsillectomy: report of two cases. J Clin Anesth. 2006;18(2):129–31.CrossRefGoogle Scholar
  55. 55.
    Mertes PM, Tajima K, Regnier-Kimmoun MA, et al. Perioperative anaphylaxis. Med Clin North Amer. 2010;94(4):761–89.CrossRefGoogle Scholar
  56. 56.
    Dewachter P, Mouton-Faivre C, Emala CW. Anaphylaxis and anesthesia: controversies and new insights. Anesthesiology. 2009;111(5):1141–50.PubMedCrossRefGoogle Scholar
  57. 57.
    Grzybowski M, Ownby DR, Rivers EP, Ander D, Nowak RM. The prevalence of latex-specific IgE in patients presenting to an urban emergency department. Ann Emerg Med. 2002;40(4):411–9.PubMedCrossRefGoogle Scholar
  58. 58.
    Barker KN, Flynn EA, Pepper GA, et al. Medication errors observed in 36 health care facilities. Arch Intern Med. 2002;162:1897–903.PubMedCrossRefGoogle Scholar
  59. 59.
    Bowdle TA. Drug administration errors from the ASA closed claims project. ASA Newsl. 2003;67(6):11–3.Google Scholar
  60. 60.
    Webster CS, Merry AF, Larsson L, et al. The frequency and nature of drug administration error during anesthesia. Anaesth Intensive Care. 2001;29:494–500.PubMedGoogle Scholar
  61. 61.
    Llewllyn RL, Gordon PC, Wheatcroft D, et al. Drug administration errors: a prospective survey from three South African teaching hospitals. Anaesth Intensive Care. 2009;37:93–8.Google Scholar
  62. 62.
    Orser BA, Chen RJ, Yee DA. Medication errors in anesthetic practice: a survey of 687 practitioners. Can J Anaesth. 2001;48:139046.Google Scholar
  63. 63.
    Martin DE Medication error persists APSF Newsletter 2008. Available at
  64. 64.
    Jain RK, Katiyar S. Drug errors in anaesthesiology. Indian J Anaesth. 2009;53(5):539–42.PubMedGoogle Scholar
  65. 65.
    Riviere A, Piriou V, Durand D, et al. Medication errors in anaesthesia: a review of reports from the French Health Products Agency. Ann Fr Anesth Reanim. 2012;31(1):6–14.PubMedCrossRefGoogle Scholar
  66. 66.
    Merry AF, Anderson BJ. Medication errors- new approaches to prevention. Paediatr Anaesth. 2011;21(7):743–53.PubMedCrossRefGoogle Scholar
  67. 67.
    Merry AF, Webster CS, Hannam J, et al. Multimodal system designed to reduce errors in recording and administration of drugs in anaesthesia: prospective randomized clinical evaluation. BMJ. 2011;343:d5543.PubMedCrossRefGoogle Scholar
  68. 68.
    Cranshaw J, Gupta KJ, Cook TM. Litigation related to drug errors in anaesthesia: an analysis of claims against the NHS in England 1995–2007. Anaesthesia. 2009;64(12):1317–23.PubMedCrossRefGoogle Scholar
  69. 69.
    Joint Commission Guidelines. Guidelines for the implementation of the Universal protocol for the prevention of wrong site, wrong procedure and wrong person surgery. Accessed 1 Mar 2012.
  70. 70.
    Rosenberg LH, Politano AD, Sawyer RG. The surgical care improvement project and prevention of post-operative infection, including surgical site infection. Surg Infect (Larchmt). 2011;12(3):163–8.CrossRefGoogle Scholar
  71. 71.
    Balch CM, Oreskovich MR, Dyrbye LN, et al. Personal consequences of malpractice lawsuits on American surgeons. J Am Coll Surg. 2011;213(5):657–67.PubMedCrossRefGoogle Scholar
  72. 72.
    Gazoni FM, Amato PE, Malik ZM, et al. The impact of perioperative catastrophes on anesthesiologists: results of a national survey. Anesth Analg. 2012;114(3):596–603.PubMedCrossRefGoogle Scholar
  73. 73.
    Gazoni FM, Durieux ME, Wells L. Life after death: the aftermath of perioperative catastrophes. Anesth Analg. 2008;107:591–600.PubMedCrossRefGoogle Scholar
  74. 74.
    Souter KJ, Gallagher TH. The disclosure of unanticipated outcomes of care and medical errors: what does this mean for anesthesiologists? Anesth Analg. 2012;114(3):615–21.PubMedCrossRefGoogle Scholar
  75. 75.
    Osman NI, Collins GN. Urological litigation in the UK National Health Service (NHS): an analysis of 14 years of successful claims. BJU Int. 2011;108(2):162–5.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  1. 1.Department of Anesthesiology, Icahn School of Medicine at Mount SinaiThe Mount Sinai Medical CenterNew YorkUSA

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