Identification of surgical complications and deaths: an assessment of the traditional surgical morbidity and mortality conference compared with the American College of Surgeons-National Surgical Quality Improvement Program

J Am Coll Surg. 2006 Nov;203(5):618-24. doi: 10.1016/j.jamcollsurg.2006.07.010. Epub 2006 Sep 27.


Background: Despite advances by surgeons in assessing quality and safety, the traditional surgical morbidity and mortality (M&M) conference has mostly remained unchallenged and unchanged. The goal of this study was to compare data as reported in a traditional M&M conference to data collected using the American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) techniques.

Study design: A retrospective study was performed comparing data from the M&M conference in a general surgery division, in which complications and deaths were identified by residents or attendings, to data compiled by a nationally audited nurse reviewer from the ACS-NSQIP from July 1, 2002, to June 30, 2003.

Results: Mortality rates calculated by traditional M&M conference (53 deaths in 5,905 patients), compared with the ACS-NSQIP nurse reviewer (28 deaths in 1,439 patients; 24% sample), were 0.9% versus 1.9%, respectively (p=0.001). Complication rates reported in M&M were 6.4% versus 28.9% ACS-NSQIP (p<0.0001). Subgroup analyses showed that mortality rates, as reported in conference, were substantially lower for both in-hospital and postdischarge patients, when compared with ACS-NSQIP. All subclassifications of complications, as presented in conference, were also lower, compared with ACS-NSQIP.

Conclusions: Traditional surgical M&M reporting considerably underreports both in-hospital and postdischarge complications and deaths as compared with ACS-NSQIP. Approximately one of two deaths and three of four complications were not reported in the M&M conference at our institution. A Web-based reporting system based on an ACS-NSQIP platform was created to automate, facilitate, and standardize data on surgical morbidity and mortality.

Publication types

  • Comparative Study

MeSH terms

  • Boston
  • Clinical Competence
  • Congresses as Topic
  • Education, Medical, Graduate / standards*
  • General Surgery / education*
  • General Surgery / standards
  • Hospitals, General / standards
  • Humans
  • Internship and Residency / standards*
  • Medical Audit
  • Postoperative Complications / classification*
  • Postoperative Complications / epidemiology
  • Postoperative Complications / mortality
  • Program Evaluation
  • Quality Assurance, Health Care / methods*
  • Retrospective Studies
  • Risk Management
  • Surgical Procedures, Operative / adverse effects*
  • Surgical Procedures, Operative / mortality
  • United States