[Interdisciplinary complications conference--also a (simple) kind of quality assurance]

Documentation of complications is a "must" today. Several societies have been formed and several systems of documentation exist to fulfill these requirements. But there are also very simple tools for quality management in every hospital. Since 1995 all surgical/orthopedic interventions have been prospectively recorded at the hospital of Frutigen. Every other month a list of all operations and their complications is put together by the two surgeons-in-chief. This list is then presented at the so-called interdisciplinary complications-conference. This meeting is open to all employees of the hospital and to all medical doctors of the region. From the 1st January 1995 to the 31st December 2001 7396 surgical interventions were performed on in- or outpatients. 134 complications (1.8%) occurred. These were: 49/7396 infections (0.7%), 14/1395 re-osteosyntheses (1%), 21/7396 hematomas requiring evacuation (0.3%), 8/7396 disturbances in wound healing (0.1%) and 42 other, postoperative complications. Postoperative infection occurred most frequently after appendectomies 10/251 (4%), the rate after internal fixation was 0.6% (9/1395). Hematomas were encountered most frequently after total joint replacement (hip and knee) 4/180 (2.2%), followed by inguinal hernias 4/287 (1.4%). The rate of re-osteosynthesis was highest after internal fixation of proximal humerus fractures 5/58 (8.6%). This systematic documentation of complications allows an analysis of the operative/perioperative management. By introducing specific measures (compression-bandage after operations of inguinal hernias and total hip prosthesis, new implant with rotational stability for proximal humerus fractures) an attempt can be made to reduce the rate of the most frequent complications. The public presentation of the complications at the meeting makes it possible to communicate good and bad results to the whole staff including the general practitioners, and the interdisciplinary mode of discussion permits the inclusion of not only the surgical but also all other possible aspects of the treatment of the patients.