Quantifying recall bias in surgical safety: a need for a modern approach to morbidity and mortality reviews

Despite recent investments into reducing errors and adverse events in health care, methods for quality improvement in surgery are outdated and ineffective. Most current efforts in this field are centred around morbidity and mortality conferences (MMCs), which have remained unchanged for over 100 years. The present study aimed to quantify the recall bias associated with details from surgical cases.

We gathered immediate postoperative questionnaires from 1 surgeon, 1 fellow and 11 trainees following 25 routine surgical cases. Information elicited included their perceived level of concentration, mental preparedness and assessment of whether the procedure deviated from its expected course, including any intraoperative adverse events. We readministered the questionnaire 7−9 days later to assess participants’ ability to recall important aspects of the procedure.

After 1 week, members of the surgical team were universally inaccurate in their recollection of even major details from the operating room. Although most participants felt mentally prepared and perceived no issues with concentration during the case, all participants misclassified operations as having been performed with or without adverse events in almost every included case.

Our findings show that recall bias regarding surgical safety events is exceedingly common. This likely has a major impact on the integrity of data presented at MMCs.