Practice of Medicine


Reducing the Risk of Perioperative Pulmonary Aspiration Among Anesthesiologists

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Aspiration accounts for 11% of medical malpractice claims among anesthesiologists insured by MagMutual. While anesthesia is generally safe, respiratory complications such as anesthesia-related aspiration can be severe or even fatal, representing a significant claims risk for anesthesiologists.

To help anesthesiologists reduce that number, MagMutual’s medical faculty and risk consultants have analyzed our claims data, determined the main causes of claims related to aspiration and developed strategies to improve patient outcomes. 

Top Risks

The main causes of claims related to aspiration are:

  • Improper Technique
  • Failure to Assess Equipment Access
  • Provider-to-Provider Communication

    Top Strategies for Reduction

    Based on these top risk drivers, implementing the following clinical and operational strategies can help you prevent unexpected outcomes and increase defensibility of a medical malpractice claim:

    Clinical strategies

    • Identify patients at risk for aspiration by performing a preoperative evaluation of their medical history and physical examination, including risk factors such as obesity, gastroesophageal reflux disease (GERD) and a history of prior aspiration events.
    • Require strict adherence to NPO guidelines to ensure that patients have an empty stomach prior to surgery, thereby reducing the risk of aspiration.
    • Prior to induction of anesthesia, decompress gastric contents by placing a nasogastric tube in patients at high risk of aspiration, such as patients with a bowel obstruction or patients who are prone to vomiting. Additionally, be aware of which patients require rapid sequence intubation (RSI) rather than typical intubation method or sedation when patients may lose the ability to protect their airway, based on their comorbidities or acute illness to minimize the risk of aspiration. 

    Operational strategies

    • Ensure that proper suction equipment is available in the procedure room in case of vomiting.
    • Promote provider awareness and communication regarding NPO patient violations to minimize the risk of aspiration during the procedure. 

    Other Top Risks

    Though aspiration accounts for a significant amount of claims among anesthesiologists according to our data, we’ve identified several other drivers of loss based on claims frequency: 

    Risk Drivers by Top Cause
    Key Loss DriverTop Clinical Loss CauseTop Non-Clinical Contributing Factor% of Claims
    (A) Medication errorTreatmentPatient Non-Compliance15%
    (B) Respiratory failureProceduralCommunication13%
    (C) Critical hypotensionProceduralDocumentation13%
    (D) AspirationProceduralDocumentation11%
    (E) Failed airwayProceduralCommunication6%
    (F) Nerve injuryProceduralCommunication6%

    Risk Drivers by Frequency

    Download the full report with indemnity payment information and strategies for all the key loss drivers to help you reduce risk in the top areas that claims occur.  

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    Data Collection & Methodology

    Data is based on MagMutual closed claims data from 2011-2021 and corresponding exposure data. Clinical and non-clinical loss drivers are based on an in-depth review of each claim by a medical professional or clinical risk consultant. Risk reduction strategies are based on input from practicing physicians.


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    The information provided in this resource does not constitute legal, medical or any other professional advice, nor does it establish a standard of care. This resource has been created as an aid to you in your practice. The ultimate decision on how to use the information provided rests solely with you, the PolicyOwner.