Discrepancy Between Neurosurgery Morbidity and Mortality Conference Discussions and Hospital Quality Metric Standards.

Discrepancy Between Neurosurgery Morbidity and Mortality Conference Discussions and Hospital Quality Metric Standards.

World Neurosurg. 2018 Apr 04;:

Authors: Rotman LE, Davis MC, Salehani AA, Broadwater DR, Reeve NH, Riley KO

Abstract
OBJECTIVE: Medical institutions use quality metrics to track complications seen in hospital admissions. Similarly, morbidity and mortality (M&M) conferences are held to peer review complications. The purpose of this study was to compare the complications identified in a cohort of patients within 30 days of neurosurgical intervention with those captured in a cohort of M&M conferences.
METHODS: All complications that occurred within 30 days of surgery were obtained for patients admitted to the neurosurgical service between May and September 2013. All patients discussed in M&M conference between August 2012 and February 2015 were included in a second data set. Complications were subdivided into four categories and compared between the two cohorts.
RESULTS: 749 postoperative complications were identified, including 52 urinary tract infections, 52 pneumonias, 15 deep vein thromboses, 19 strokes, 75 seizures, 25 wound infections, 6 cardiac arrests, and 162 reoperations. 85 M&M cases were reviewed, identifying 9 strokes, 3 seizures, 8 wound infections, 13 hematomas, 7 intraoperative errors and 11 postoperative deaths. The M&M cohort demonstrated higher rates of neurological complications (P < 0.0001) and surgical complications (P<0.0001). The neurosurgical admission cohort exhibited higher rates of general medical adverse events (P=0.0118) and infectious complications (not surgical wound related, P=0.0002).
CONCLUSION: Both neurosurgical service inpatient complications and complications discussed in M&M provide valuable opportunities for identifying areas in need of quality improvement. As our nation moves towards an outcomes reimbursement model, neurosurgical programs should adjust M&M conferences to reflect both technical operative complications as well as more common complications.

PMID: 29626685 [PubMed - as supplied by publisher]

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