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Study objective To provide a contemporary medicolegal analysis of claims brought against anesthesia providers in the United States related to neuraxial blocks for surgery and obstetrics. Design In this retrospective analysis, we analyzed closed claims data from the Controlled Risk Insurance Company (CRICO) Comparative Benchmarking System (CBS) database between 2007 and 2016. Setting Closed claims from inpatient and outpatient settings related to neuraxial anesthesia for surgical procedures and obstetrics. Patients Forty-five claims were identified for analysis. These patients underwent a variety of surgical procedures, included both children and adults, and with ages ranging from 6 to 82. Interventions Patients receiving neuraxial anesthesia (spinals, epidurals) for surgery or obstetrics. Measurements Data collected includes patient demographics, alleged injury type/severity, surgical specialty, likely contributors to the alleged damaging event, and case outcome. Some of the data were drawn directly from coded variables in the CRICO database, and some were gathered from narrative case summaries. Main results Settlement payments were made in 20% of claims. Reported adverse outcomes ranged from temporary minor to permanent major injuries. Most closed claims were classified as permanent minor injuries. The greatest number of claims involved residual weakness and radiculopathy resulting from epidurals. The largest contributing factor to these injuries was noted to be “Technical Knowledge/Performance” of the anesthesia provider followed by “Missing or Documentation Error.” Over half of the claims arose from obstetric patients (31%) and patients undergoing orthopedic surgery (27%). Conclusions Patients with pre-existing radiculopathy or comorbidities may warrant more thorough informed consent about the increased risk of injury. Additionally, prompt follow-up, monitoring, and documentation of post-operative symptoms, such as weakness or radiculopathy, are crucial for improving patient safety and satisfaction. More timely communication with the patient and the surgical team regarding residual neurologic symptoms is important for earlier diagnosis of injury.

Objectives To determine if the Patient-Reported Outcome Measurement Information System (PROMIS) physical function, pain interference, self-efficacy, and global rating of normal function (GRNF) scales are able to accurately characterize a patient’s acceptable symptom state (PASS). Design A cross-sectional analysis, using receiver operator curves and chi-square analysis to explore criteria to determine thresholds (80% and 95% sensitivity/specificity) for PASS that are applicable to PROMIS and GRNF scales. Setting Phone survey after primary care. Participants Patients (N=94) attending primary care for musculoskeletal problems. Interventions Not applicable. Main Outcomes Measures Accuracy and proportion of patients classified as PASS Yes or No. Results Receiver operator curve analysis showed significant area under the curve (AUC) values for each PROMIS scale (AUC>.72) and the GRNF rating (AUC=.74). Identified PROMIS thresholds suggested PASS was achieved when scores were at or slightly worse than the US population average. A score of ≥7 and ≤4 characterized patients that were PASS Yes and No, respectively, on the GRNF rating. A moderate (80%) specificity/sensitivity criteria yielded 72.3%-73.5% accuracy for a majority of participants (>69.9%). Conclusion This analysis suggests the PROMIS and GRNF scales are able to characterize PASS status with moderate accuracy (∼70%) for a large portion of patients (∼70%). New to this study is the association of self-efficacy with PASS status. PROMIS scales at or slightly worse than the US population average characterized PASS status.

BACKGROUND: Understanding how symptoms influence patient judgements of their health informs providers where to direct care. Patient reported physical outcomes (physical function, pain interference) and self-efficacy of symptom management (SEsm)) predict a patient's health state (i.e. patient acceptable symptom state (PASS)). However, it's unclear if therapist should consider a psychological outcome like SEsm separately or combine this outcome with other physical outcomes for clinical decisions. OBJECTIVE: To determine if patient reported outcome information system (PROMIS) SEsm scale when combined with PROMIS physical function or pain interference is able to accurately predict a patient's health state defined by PASS. METHODS: One hundred ninety-six patients (initial sample (n = 94) and separate sample (n = 102)) were surveyed by phone after care for a musculoskeletal problem. Patients completed PASS, PROMIS physical function, pain interference and SEsm outcomes. Logistic regression was used to estimate odds ratios (OR) for determining PASS in the initial sample. Criteria for determining PASS developed from the regression analysis were applied to a separate sample to assess accuracy. Accuracy for PASS status were also assessed at 1-7 days and 45-60 days. RESULTS: Three combinations including SEsm/pain interference and SEsm/physical function showed significant OR's (

Methods 115 thoracic spine vertebral levels(n=230 pedicles) were evaluated. After the vertebral body was removed, K-wires were inserted retrograde along the four boundaries of the pedicle. Using digital calipers, we measured width of the SAF and pedicle at the isthmus, and from the borders of the superior articular facet(SAF) to the boundaries of the pedicle. We calculated the morphologic relationship of the VL and center of the pedicle, to the SAF. Results 229 pedicles were measured(1 excluded due to SAF fracture). The VL was identifiable in all specimens medial to midline SAF, forming the roof of the spinal canal, and confluent with the medial pedicle wall(MPW). The mean distance from SAF midline to the MPW was 1.34±1.25mm medial. The MPW was lateral to SAF midline in 34(14.85%) pedicles, with a mean distance of only 0.52±0.51mm lateral. The mean distance from SAF midline to center of the pedicle(COP) was 2.22±1.49mm lateral. The COP was medial to SAF midline in only 9(3.39%) pedicles. The mean distance from the SAF superior border to the COP was 13.15±2.47mm.