Original scientific article
Identification of Surgical Complications and Deaths: An Assessment of the Traditional Surgical Morbidity and Mortality Conference Compared with the American College of Surgeons-National Surgical Quality Improvement Program

Presented at the American College of Surgeons 91st Annual Clinical Congress, San Francisco, CA, October 2005.
https://doi.org/10.1016/j.jamcollsurg.2006.07.010Get rights and content

Background

Despite advances by surgeons in assessing quality and safety, the traditional surgical morbidity and mortality (M&M) conference has mostly remained unchallenged and unchanged. The goal of this study was to compare data as reported in a traditional M&M conference to data collected using the American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) techniques.

Study design

A retrospective study was performed comparing data from the M&M conference in a general surgery division, in which complications and deaths were identified by residents or attendings, to data compiled by a nationally audited nurse reviewer from the ACS-NSQIP from July 1, 2002, to June 30, 2003.

Results

Mortality rates calculated by traditional M&M conference (53 deaths in 5,905 patients), compared with the ACS-NSQIP nurse reviewer (28 deaths in 1,439 patients; 24% sample), were 0.9% versus 1.9%, respectively (p = 0.001). Complication rates reported in M&M were 6.4% versus 28.9% ACS-NSQIP (p < 0.0001). Subgroup analyses showed that mortality rates, as reported in conference, were substantially lower for both in-hospital and postdischarge patients, when compared with ACS-NSQIP. All subclassifications of complications, as presented in conference, were also lower, compared with ACS-NSQIP.

Conclusions

Traditional surgical M&M reporting considerably underreports both in-hospital and postdischarge complications and deaths as compared with ACS-NSQIP. Approximately one of two deaths and three of four complications were not reported in the M&M conference at our institution. A Web-based reporting system based on an ACS-NSQIP platform was created to automate, facilitate, and standardize data on surgical morbidity and mortality.

Section snippets

Methods

Morbidity and mortality rates were tabulated from the traditional weekly M&M conference from the General Surgical Services at the Massachusetts General Hospital for the academic year July 1, 2002, to June 30, 2003, and compared with M&M as determined by the NSQIP nurse-reviewer during the identical time period. Occurrence rates were calculated as the number of total occurrences divided by the number of major general surgical cases. Univariate analyses of the data were performed using chi-square

Results

Of the 7,916 procedures performed by the General Surgical Services at our hospital in the academic year of 2002 to 2003, 5,905 met NSQIP inclusion criteria. Our NSQIP nurse-reviewer captured 1,439 of these procedures, a 24% sample.

Mortality rate, as calculated by the traditional M&M conference compared with the NSQIP nurse-reviewer, was 0.9% versus 1.9% (p = 0.001)(Table 1). By extrapolation from the 24% sample size, this means that 1 of every 2 deaths was not presented at the M&M conference,

Discussion

We found that the traditional M&M conference at our institution substantially underreported both in-hospital and postdischarge complications and deaths as compared with data collected using ACS-NSQIP techniques. Approximately one of two deaths and three of four complications were not presented in the M&M conference at our institution.

Sparse information about the accuracy of M&M conferences exists in the medical literature, so it is difficult to know if these findings are an isolated event at

Acknowledgment

We would like to thank Sherwood Hughes and Steve Merzlak, and Henry Chueh, Mike Franklin, and Kathryn Lau from the MGH Laboratory of Computer Science for their efforts in creating our intranet-based reporting tool for M&M conference.

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Competing Interests Declared: None.

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