MEASURING POSTOPERATIVE COMPLICATIONS IN GENERAL-SURGERY PATIENTS USING AN OUTCOMES-BASED-STRATEGY - COMPARISON WITH COMPLICATIONS PRESENTED AT MORBIDITY AND MORTALITY ROUNDS

Background. This study was undertaken to compare the incidence of adve rse postoperative outcomes recorded in a prospective general surgery d atabase with that identified through weekly morbidity and mortality (M &M) rounds and to measure the impact of feedback of information to the providers of care. Methods. Data were collected on patients admitted to one general surgery service between October 1, 1995, and May 15, 19 96, and recorded in a computer database. Postoperative complications w ere graded in severity from I (minor) to IV (mortality). Results. Of 4 79 admissions entered into the database during the study period 325 (3 11 patients) led to operations and were further analyzed. Admissions r esulting in complications were associated with longer hospital stays, regardless of complication grade, compared to uncomplicated admissions (p < 0.01). A total of 29 of 106 patients with postoperative complica tions were presented at M&Ms (27.4%). Whereas 15.4% of database patien ts with grade I complications were presented at M&Ms, this proportion increased to 22.2% for grade IIa, 34.8% for grade IIb, 33.3% for grade III, and 87.5% for grade IV (p < 0.05 for grade I, IIa, and IIb compa red to grade IV). A total of 58 of 142 patients in the first part of t he study period developed complications (40.8%), compared to 53 of 183 patients in the second part of the study (29%, p = 0.034). Conclusion s. Although most severe complications are recorded at M&M rounds, a la rge proportion of complications remain unreported. Monitoring of outco mes may contribute to improvements in quality of care.