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Can systematic analysis of morbidity and mortality reduce complication rates in neurosurgery?

  • Clinical Article
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Abstract

Objective

Morbidity and mortality conferences (M&MC) are a traditional part of residency programs in a large number of countries to increase the training quality. The purpose of the present publication is to report our experience with a monthly M&MC over a 5-year period and, in particular, to describe the methods to identify critical cases, the system of analysis, classification of morbidity and mortality, and the resulted impact.

Method

Monthly identification of M&M was done through a system of electronically coding hospital course at the time of discharge. Morbidity was classified as moderate if sequels resolved within 3 months or otherwise as severe. Morbidity included management complications not directly related the neurosurgical procedure, such as pneumonia or thromboembolism. Mortality was classified as related to surgery or unrelated, e.g., after severe trauma. Mortality in relation to surgery was subclassified in terms of causal relation or not. Statistical comparison of incidence rates was calculated statistically.

Results

Overall management morbidity rate was 7.1%, and mortality with causal relation to surgery was 0.38%. The leading cause of morbidity was additional neurological deficit (25%) followed by postoperative hemorrhage (23%) and second unplanned surgery due to incomplete result of the primary procedure (14%). Overall, the monthly incidence varied without a discernable annual pattern. Over the years, there were only a handful of guideline updates triggered by incidents.

Conclusion

Our system to identify complication proved to be reliable. During the study period, the M&MC developed into a well-accepted instrument of quality control and problem-oriented teaching, but the impact on quality improvement remained questionable.

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Conflicts of interest

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Authors and Affiliations

  1. Department of Neurosurgery, Heinrich-Heine-Universität, Düsseldorf, Germany

    Hans-Jakob Steiger & Daniel Hänggi

  2. Department of Neurosurgery, Westfälische Wilhelms-Universität, Münster, Germany

    Walter Stummer

  3. Neurochirurgische Klinik, Universitätsklinikum, Moorenstr. 5, 40225, Düsseldorf, Germany

    Hans-Jakob Steiger

Authors
  1. Hans-Jakob Steiger
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  2. Walter Stummer
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  3. Daniel Hänggi
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Corresponding author

Correspondence to Hans-Jakob Steiger.

Additional information

Comment

This manuscript details 5 years of morbidity and mortality data comprising 9,885 surgical cases. The data was captured in discharge records. Every patient had a notation in the chart indicating satisfactory or complicated outcome. Guideline changes were examined as well as statistical consideration of data. This article suggests that morbidity and mortality conference is a useful tool for auditing, education, and practice improvement.Patrick Connolly Christopher Loftus Philadelphia, PA, USA

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Steiger, HJ., Stummer, W. & Hänggi, D. Can systematic analysis of morbidity and mortality reduce complication rates in neurosurgery?. Acta Neurochir 152, 2013–2019 (2010). https://doi.org/10.1007/s00701-010-0822-3

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  • DOI: https://doi.org/10.1007/s00701-010-0822-3

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