title: Identifying Adverse Events in Pediatric Surgery: Comparing Morbidity and Mortality Conference with the NSQIP-Pediatric System.
abstract: BACKGROUND
  Recent improvements to morbidity and mortality (M&M) conference have focused on the case review system. However, case selection occurs by physician reporting, which is limited by selection bias. We compared the effectiveness of our M&M conference with the NSQIP-Pediatric (NSQIP-P) system for identifying adverse events.
  
  
  METHODS
  Complications from January 2010 to September 2015 were compared between M&M and NSQIP-P. Only M&M patients meeting NSQIP-P criteria were compared with patients from the NSQIP-P system; exclusions were studied separately. Complication rates in M&M conference before and after a 2012 format change designed to increase case reporting were also compared.
  
  
  RESULTS
  Detection of mortality in M&M conference and NSQIP-P was not different. Morbidity events identified by NSQIP-P were significantly higher than M&M conference during the entire study period (194 vs 100 occurrences/1,000 cases) (p < 0.0001). Morbidity occurrences in M&M conference increased with the 2012 improvements, however, they still remained less than that identified by NSQIP-P (226 vs 141 occurrences/1,000 cases) (p < 0.0001). Of 863 patients presented in M&M conference, 210 were excluded from direct comparison because they did not meet NSQIP-P criteria. These included 62 deaths and 287 occurrences of morbidity. Their analysis in M&M conference resulted in 32 action initiatives directed at system failures.
  
  
  CONCLUSIONS
  The NSQIP-P identified more complications than M&M. The M&M conference improvements increased reported cases, but they still remained lower than NSQIP-P. However, M&M conference identified events resulting in systems changes that would not have been identified by NSQIP-P. Although NSQIP-P captures occurrences to compare large patient cohorts, M&M analyzes singular failures and initiates direct interventions. Integration of these systems can optimize their usefulness in quality improvement.
authors.affiliation: Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH Department of Quality Improvement Services, Nationwide Children's Hospital, Columbus, OH.
authors.forename: Barrett P
authors.initials: BP
authors.lastname: Cromeens
authors.forename: Richard E
authors.initials: RE
authors.lastname: Lisciandro
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Brilli
authors.forename: Johanna R
authors.initials: JR
authors.lastname: Askegard-Giesmann
authors.forename: Brian D
authors.initials: BD
authors.lastname: Kenney
authors.forename: Gail E
authors.initials: GE
authors.lastname: Besner
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology*; D058996:Quality Improvement / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D015983:Selection Bias; D013514:Surgical Procedures, Operative / Q000009:adverse effects* / Q000401:mortality* / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology