Department of Neurosurgery, Heinrich-Heine-Universität, Düsseldorf, Germany.
Acta Neurochir (Wien). 2010 Dec;152(12):2013-9. doi: 10.1007/s00701-010-0822-3. Epub 2010 Oct 9.
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.
在许多国家，发病率和死亡率会议（M＆MC）是住院医师培训计划的传统组成部分，以提高培训质量。本出版物的目的是报告我们在过去 5 年中每月进行一次 M＆MC 的经验，特别是描述识别关键病例的方法、分析系统、发病率和死亡率分类，以及由此产生的影响。
通过在出院时对医院病程进行电子编码的系统，每月确定 M＆MC。如果后遗症在 3 个月内解决，则将发病率归类为中度，否则归类为重度。发病率包括与神经外科手术无关的管理并发症，例如肺炎或血栓栓塞。死亡率被归类为与手术相关或不相关，例如在严重创伤后。与手术相关的死亡率分为因果关系或非因果关系。发病率的统计比较通过统计学计算。
总体管理发病率为 7.1％，与手术相关的死亡率为 0.38％。发病率的主要原因是新的神经功能缺损（25％），其次是术后出血（23％）和由于原发性手术结果不完整而进行的第二次非计划手术（14％）。总体而言，每月的发病率没有明显的年度模式。多年来，只有少数几次指南更新是由事件触发的。
我们识别并发症的系统被证明是可靠的。在研究期间，M＆MC 已发展成为质量控制和以问题为导向的教学的有效工具，但对质量改进的影响仍存在疑问。
