Factors contributing to adverse perioperative events in adults with congenital heart disease: A structured analysis of cases from the closed claims project

Bryan G. Maxwell, Karen L. Posner, Jim K. Wong, Daryl A. Oakes, Nate E. Kelly, Karen B. Domino, Chandra Ramamoorthy

Research output: Contribution to journalArticlepeer-review

17 Scopus citations


Objective: Prior investigations have suggested that the rapidly growing population of adults with congenital heart disease is at increased risk of perioperative morbidity and mortality, but information is limited on the nature of those perioperative factors that may relate to adverse outcomes. We sought to use a national claims database to describe the contribution of perioperative factors to adverse outcomes and compare contributing factors in cardiac vs. noncardiac operations. Design: The study is a retrospective in-depth structured analysis of cases from the Anesthesia Closed Claims Project database. Setting: We examined the largest national anesthesia malpractice claims database. Patients: We included all claims cases involving adult patients with congenital heart disease (CHD). Interventions: Patients in this retrospective analysis were classified by type of surgery (cardiac or noncardiac). Outcome Measures: Perioperative factors contributing to an adverse event were assessed by an expert panel of cardiac anesthesiologists. Results: Of 21 confirmed cases, 11 (52%) involved cardiac procedures and 10 (48%) noncardiac procedures. The most common factors contributing to the adverse event in cardiac cases were surgical technique (73% of cases) and intraoperative anesthetic care (55%), whereas in noncardiac cases, postoperative monitoring/care (50%), CHD (50%) and preoperative assessment or optimization (40%) were most common. The factors contributing to the patient injury differed similarly: in cardiac cases, the most common factors were intraoperative anesthetic care (55%) and surgical technique (45%) compared with postoperative monitoring/care (50%) and CHD (50%) in noncardiac cases. Conclusions: Within the limitations of a small number of events in a claims-based database, this study offers advantages of being a national, structured analysis of real cases to provide detailed information on phenomena that are otherwise abstract and hypothesized by expert opinion. These results should help affirm the role of anesthesiologists in acquiring and executing expertise as consultants in perioperative medicine for adults with congenital heart disease patients.

Original languageEnglish (US)
Pages (from-to)21-29
Number of pages9
JournalCongenital Heart Disease
Issue number1
StatePublished - Jan 1 2015


  • Adult congenital heart disease
  • Anesthesiology
  • Closed claims project
  • Noncardiac surgery
  • Perioperative complications

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Surgery
  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine


Dive into the research topics of 'Factors contributing to adverse perioperative events in adults with congenital heart disease: A structured analysis of cases from the closed claims project'. Together they form a unique fingerprint.

Cite this