Miller David C, Filson Chris P, Wallner Lauren P, Montie James E, Campbell Darrell A, Wei John T
Department of Urology, University of Michigan Health System, Ann Arbor, Michigan 48109, USA.
Urology. 2006 Nov;68(5):931-7. doi: 10.1016/j.urology.2006.06.018.
The detection of postoperative complications is a necessary quality-of-care endeavor. Despite its historical role, the Morbidity and Mortality (M&M) Conference depends on voluntary reporting and may be an insufficient mechanism for comprehensive complication surveillance. In response to this concern, we compared the concordance between complications voluntarily reported at the M&M Conference and those identified prospectively by the National Surgical Quality Improvement Program (NSQIP).
For a single calendar year (2004), we compiled a comprehensive list of complications that were either identified and voluntarily entered into our department's electronic M&M Conference database and/or identified prospectively (from an explicit sample of cases) by a trained research associate-based NSQIP protocol. For analytic purposes, we treated NSQIP as the reference standard for the detection of complications. We then determined the sensitivity of the M&M Conference for the identification of complications at a patient and event level. Logistic regression modeling was used to evaluate for an association between complication category (ie, organ system affected) and detection by the M&M Conference.
The NSQIP detected 347 complications in 176 patients. Using this reference standard, the patient-level and event-level sensitivity of the M&M Conference was 25% (44 of 176) and 14% (47 of 347), respectively. The sensitivity of the M&M Conference varied by NSQIP complication category (P = 0.08). Circulatory events were 11 times more likely to be reported at the M&M Conference than urinary complications (odds ratio 11.3, 95% confidence interval 2.4 to 53.7).
Compared with the NSQIP, the M&M Conference has a low (but variable) sensitivity for the detection of postoperative complications. Therefore, despite its limitations, the NSQIP may provide a better foundation for urologic quality improvement endeavors.
术后并发症的检测是一项必要的医疗质量工作。尽管发病率和死亡率（M&M）会议有着历史作用，但它依赖于自愿报告，可能是全面并发症监测的一种不充分机制。针对这一问题，我们比较了在M&M会议上自愿报告的并发症与国家外科质量改进计划（NSQIP）前瞻性识别出的并发症之间的一致性。
在单一日历年（2004年），我们编制了一份综合并发症清单，这些并发症要么是被识别并自愿录入我们科室的电子M&M会议数据库，要么是由经过培训的研究助理依据NSQIP方案前瞻性识别（从明确的病例样本中）。为了分析目的，我们将NSQIP作为并发症检测的参考标准。然后我们在患者层面和事件层面确定了M&M会议识别并发症的敏感性。使用逻辑回归模型评估并发症类别（即受影响的器官系统）与M&M会议检测之间的关联。
NSQIP在·176例患者中检测到347例并发症。以该参考标准，M&M会议在患者层面和事件层面的敏感性分别为25%（176例中的44例）和14%（347例中的47例）。M&M会议的敏感性因NSQIP并发症类别而异（P = 0.08）。与泌尿系统并发症相比，循环系统事件在M&M会议上被报告的可能性高11倍（优势比11.3，95%置信区间2.4至53.7）。
与NSQIP相比，M&M会议在检测术后并发症方面敏感性较低（但存在差异）。因此，尽管NSQIP有其局限性，但它可能为泌尿外科质量改进工作提供更好的基础。
Zotero 插件