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.

Full Abstract

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.

Learn Faster Today Improve your study skills

Author information

Author/s: Hutter, Matthew M (MM); Rowell, Katherine S (KS); Devaney, Lynn A (LA); Sokal, Suzanne M (SM); Warshaw, Andrew L (AL); Abbott, William M (WM); Hodin, Richard A (RA);

Affiliation: Department of Surgery, Massachusetts General Hospital, Boston, MA 02114, USA. mhutter(-atsign-)partners.org

Journal and publication information

Publication Type: Comparative Study; Journal Article

Journal: Journal of the American College of Surgeons (J Am Coll Surg), published in United States. (Language: eng)

Reference: 2006-Nov; vol 203 (issue 5) : pp 618-24

Dates: Created 2006/11/06; Completed 2006/12/12; Revised 2008/11/21;

PMID: 17084322, status: MEDLINE (last retrieval date: 12/26/2008)

Sourced from the National Library of Medicine. Abstract text and other information may be subject to copyright.

Comments and Corrections

CommentIn: J Am Coll Surg. 2007 Jul;205(1):196; author reply 197. (PMID: 17617362)

External Links for this article (including full text providers, if available):

Click Electronic Full-text Provider Links to see options for finding the electronic full text links to this article. Note there may be a subscription or fee required for access to the full text. See our FAQ for information on finding FREE full text articles.

This article may also be located in paper journal collections available in many libraries. Use the Journal and Publication Information above to find the full article.

MeSH headings (categories)

This article was linked to the MESH Headings shown below.

Boston
Clinical Competence
Congresses as Topic
Education, Medical, Graduate - standards
General Surgery - education; standards
Hospitals, General - standards
Humans
Internship and Residency - standards

Medical Audit
Postoperative Complications - classification; epidemiology; mortality
Program Evaluation
Quality Assurance, Health Care - methods
Retrospective Studies
Risk Management
Surgical Procedures, Operative - adverse effects; mortality
United States

These are the highest related articles currently in the database:

See 100+ related articles.