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.
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.


METHODS
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.
Hutter
Matthew M
MM
Department of Surgery, Massachusetts General Hospital, Boston, MA 02114, USA. mhutter@partners.org
Rowell
Katherine S
KS
Devaney
Lynn A
LA
Sokal
Suzanne M
SM
Warshaw
Andrew L
AL
Abbott
William M
WM
Hodin
Richard A
RA
D001900:Boston; D002983:Clinical Competence; D003226:Congresses as Topic; D004503:Education, Medical, Graduate / Q000592:standards*; D013502:General Surgery / Q000193:education* / Q000592:standards; D006769:Hospitals, General / Q000592:standards; D006801:Humans; D007396:Internship and Residency / Q000592:standards*; D008485:Medical Audit; D011183:Postoperative Complications / Q000145:classification* / Q000453:epidemiology / Q000401:mortality; D015397:Program Evaluation; D011785:Quality Assurance, Health Care / Q000379:methods*; D012189:Retrospective Studies; D012308:Risk Management; D013514:Surgical Procedures, Operative / Q000009:adverse effects* / Q000401:mortality; D014481:United States