A. A. Antonacci1, S. Dechario1, G. Husk1, G. Stoffels3, C. L. Antonacci2, M. Jarrett4 1North Shore University And Long Island Jewish Medical Center,Manhasset, NY, USA 2Tulane University School Of Medicine,New Orleans, LA, USA 3Feinstein Institute for Medical Research,Manhasset, NY, USA 4Donald and Barbara Zucker School of Medicine at Northwell/Hofstra,Manhasset, NY, USA
Introduction: Morbidity and Mortality conference (MMC) review combined with standardized critique algorithm and relational database provides valuable data for surgical quality. Complications related to mortality and the relationship between mortality and management errors were studied.
Methods: 68,993 procedures were performed at two university based medical centers. We collected Morbidity/Mortality reports from total of 1045 complication cases comprising 268 with mortality and 777 without mortality. Complications, mortality, Clavien-Dindo scores, management error and the role of physician team and patient disease were studied.
Results:Eighteen of twenty most common complications were associated with significantly higher mortality rates (p < 0.0001;Table 1). 885 cases identified the physician team (41%), disease (26%) and both (26%) as responsible for complications. Mortality rates were higher in complications that involved patient disease compared to complications that did not (40% vs. 7%;p< 0.001). In cases with errors and 1 or more complications, each additional complication was associated with a 30% increase in odds of death (p<0.0001). Almost all complications without management errors involved disease (236/244;97%) whereas a significantly lower proportion of complications with management errors involved disease (259/641;40%,p< 0.0001). With complications not involving patient disease, mortality related to judgment errors was significantly higher than mortality related to non-judgment errors (32%vs12 %,p < 0.0001). In contrast, mortality related to technical errors was significantly lower than mortality related to non-technical errors (11%vs.29%,p<0.0001).
Conclusion:
This project describes the feasibility of combining MMC with standardized critique algorithm-based database to provide data on the frequency of complications associated with mortality and the significant relationship between mortality and judgment error.
