Mark Auspitz, Fayez Quereshy, Allan Okrainec, Alvina Tse, Sanjeev Sockalingam, Michelle Cleghorn, Timothy Jackson

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1 Mark Auspitz, Fayez Quereshy, Allan Okrainec, Alvina Tse, Sanjeev Sockalingam, Michelle Cleghorn, Timothy Jackson Division of General Surgery, University Health Network, University of Toronto, Toronto, Canada

2 Disclosure No conflicts of interest to report

3 Introduction Weekly quality of care (QOC) rounds are usually run in the format of traditional Morbidity and Mortality (M&M) conferences in the form of case presentations followed by discussions [1] Traditional M&M conferences may not capture all important complications [2,3] Studies have shown that NSQIP captures more events than M&M conferences [4,5] Currently, no studies have compared NSQIP to M&M conferences in a Canadian hospital 1. Thompson, J.S. and M.A. Prior, J Surg Res, Wanzel, K.R., C.G. Jamieson, and J.M. Bohnen, Can J Surg, Feldman, L., et al.surgery, Hutter, M.M., et al.j Am Coll Surg, Miller, D.C., et al. Urology, (5).

4 Objectives To compare the number and types of complications captured in M&M conferences to those captured by ACS-NSQIP at an academic hospital Identify the strengths and weaknesses of each method

5 Methods Study Design & Population: Allpatients admitted to the general surgery unit of Toronto Western Hospital, University Health Network between March 2012 and March 2013 were included Retrospective chart review to determine the complications for all cases submitted and discussed at M&M conferences Data Sources: Three datasets were used: i) Local NSQIP data ii) Cases submittedfor review at M&M iii) Cases actually reviewed at M&M

6 Methods Data Collection & Analysis: Identified the numbersand types of complications, including deaths, that were captured by M&M conferences and NSQIP Complications were categorized as major or minor Patients were also sub-grouped as surgical or non-surgical (some patients were admitted to the general surgery ward but did not get surgery for various reasons) Patients who were identified as having complicationsand returned to hospital within 30 days of surgery were recorded Descriptive statistics were used to analyze the data

7 Results NSQIP gathered more complications on more patients: NSQIP identified 203 complications in 143 patients compared to 91 complications in 58 patients using our existing M&M methodology NSQIP captured more surgical deaths: 12 NSQIP vs. 10 M&M M&M Rounds captured complications in non-surgical patients: All cases captured by NSQIP were from patients who underwent surgery, whereas 19% of M&M cases were from non-surgical patients M&M Rounds identified potential areas for improvement not captured in NSQIP: 27.6% of M&M patients discussed had no identifiable complications but highlighted other quality issues or educational opportunities

8 Results: Comparison of Complications No. (%) NSQIP Total M&M Cases Submitted Total Number of Patients Total Number of Deaths 12(8.4) 17 (29.3) Post-operatively 12 (8.4) 10 (17.2) No surgical intervention 0 7 (12.1) Number of Surgical Patients 143 (100) 47(81.0) Number of Non-Surgical Patients 0 11 (19.0) Patients Without Identified Complications 0 16 (27.6) Patients Returning to Hospital Within 30 Days of Surgery 47 (32.9) 11 (19.0) Total Number of Complications Captured NSQIP identified more major and minor complications NSQIP identified more re-admissions Major Complications 105 (51.7) 53 (58.2) Minor Complications 98 (48.3) 38(41.7)

9 Results: Types of Complications No. (%) NSQIP (n = 203) Total M&M Cases Submitted (n = 91) Wound Complications 65 (32.0) 18 (19.8) Superficial SSI 36 (17.7) 5 (5.5) Deep SSI 11 (5.4) 8 (8.8) Hematoma 10(4.9) 1 (1.1) Abscess 4 (2.0) 2 (2.2) Seroma 3 (1.5) 0 Disruption 1 (0.5) 2 (2.2) Gastrointestinal 38 (18.7) 23 (25.3) Respiratory 23 (11.3) 10 (11.0) On ventilator > 48 hrs 14 (6.9) 5 (5.5) Pneumonia 4 (2.0) 0 Other 5 (2.5) 5 (5.5) Sepsis 15(7.4) 10 (11.0) Urinary 15 (7.4) 5 (5.5) UTI 8 (3.9) 4 (4.4) Retention 6 (3.0) 0 Other 1 (0.5) 1 (1.1) Transfusion 13 (6.4) 4 (4.4) Cardiac / Circulatory 12 (5.9) 0 Vein Thrombosis 4 (2.0) 0 Myocardial Infarction 3 (1.5) 0 Other 5 (2.5) 0 Nervous System 5 (2.5) 2 (2.2) Renal 3 (1.5) 2 (2.2) Other 14 (6.9) 17 (18.7) NSQIP captured more instances of every category of complications than traditional methods NSQIP captured more superficial surgical site infections (36) than M&M data collection methods (5 combined) M&M methods did not capture any cardiac/circulatory, renal and nervous system complications

10 Discussion Our findings are consistent with existing published literature: NSQIP methodology captures more complications than traditional M&M rounds Hutter et al 2006, Miller et al 2006 M&M rounds provide information on complications or quality issues not collected in NSQIP and also serve an important educational function Limitations of the study are i) no gold standard exists to track complications that we can compare NSQIP data to and ii) the nature of retrospective chart reviews

11 Conclusions NSQIP gathered more complications than M&M conferences and may help hospitals identify areas needing improvement M&M conferences allow more flexibility when cataloging complications Integration of BOTHapproaches may maximize patient care and optimize trainee education

12 Questions?

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