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An eight-year analysis of surgical morbidity and mortality: data and solutions
Michael A Goldfarb1, Thomas Baker
1Department of Surgery, Monmouth Medical Center, Long Branch, NJ, USA.
Abstract:
In this article, a reproducible process for presenting, analyzing, and reducing early and late surgical morbidity and mortality (M and M) is detailed. All M and M cases presented from 1998 through 2005 at Monmouth Medical Center were categorized. Residents and nurses were empowered to report the complications. The five major categories were overwhelming disease on admission, delays in treatment, diagnostic or judgment complications, treatment complications, and technical complications. From the 53,541 operations performed over 8 years, 714 patients were presented, which included 147 deaths and 1,132 category entries. The most common problems were technical complications in 474 (66.4%) patients. The data have generated actionable solutions, many with low barriers to adoption, resulting in safer, less expensive surgical management. Surgical outcome benchmarks have been established and are used for credentialing surgeons. The "Hostile Abdomen Index" has been developed to assess the safest choice for abdominal operative access, pre- and intraoperatively. We explained the real-time process that generated solutions for the entire department as well as changes relevant to residency training and individual operative techniques.
Insights
This study presents a reproducible process for analyzing surgical morbidity and mortality (M and M). Implementing this system led to safer, more cost-effective surgical care and established outcome benchmarks.
Area of Science:
- Surgical Outcomes Research
- Patient Safety
- Healthcare Quality Improvement
Background:
- Surgical morbidity and mortality (M and M) analysis is crucial for improving patient care.
- A systematic approach to M and M review can identify areas for improvement in surgical management.
- Previous M and M processes may lack reproducibility or actionable insights.
Purpose of the Study:
- To detail a reproducible process for presenting, analyzing, and reducing surgical morbidity and mortality (M and M).
- To categorize M and M cases and identify common causes of complications.
- To establish surgical outcome benchmarks and develop tools for assessing operative risk.
Main Methods:
- A retrospective analysis of M and M cases from 1998-2005 at Monmouth Medical Center.
- Categorization of complications into five major types: overwhelming disease, treatment delays, diagnostic/judgment errors, treatment complications, and technical complications.
- Development of the 'Hostile Abdomen Index' for operative access assessment.
Main Results:
- Reviewed 714 M and M cases from 53,541 operations over 8 years.
- Technical complications were the most frequent issue, affecting 66.4% of patients.
- The process generated actionable solutions leading to safer, less expensive surgical management.
Conclusions:
- A reproducible M and M analysis process can drive significant improvements in surgical care quality and cost-effectiveness.
- Established benchmarks and tools like the 'Hostile Abdomen Index' enhance surgeon credentialing and operative decision-making.
- The implemented system facilitated department-wide solutions, residency training changes, and improved operative techniques.
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