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

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.

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.

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.

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.