Longitudinal Analysis of Morbidity and Mortality Conference Data for Head and Neck Cancer Patients

Abstract

Objectives:

Morbidity and mortality (M&M) conferences are an important forum for discussing issues related to patient care and developing potential preventative actions. While this is a valuable educational venue, accurate collection of specific patient events also permits longitudinal analysis of these data that may improve the quality of patient care.

Methods:

We changed our reporting system for M&M conference cases in February 2009 by requiring weekly reporting of events by clinical trainees. A database was created to track specific events and associate them with specific surgeons, trainees, and procedures.

Results:

During a 2-year period, we recorded 330 events (258 patients), which occurred during 4,659 surgical procedures (overall complication rate: 7.1%). Leading categories of complications included hematologic/vascular (89, 26.9%), wound-related (68, 20.6%), technical (55, 16.7%), and respiratory (42, 12.7%). One hundred and seven patients required a return to the operating room for intervention, and 29 patients needed hospital re-admission for continued care. There were 10 mortalities on the service, but 2 of these patients did not have any surgical procedure (overall mortality rate: 0.2%). An initial subset analysis of patients requiring free-flap reconstruction demonstrated 141 complications in 80 patients, which occurred during 672 surgical cases (11.9%).

Conclusions:

Active tracking of M&M conference cases provides a valuable practice-based system for clinical education and internal auditing of the quality of patient care. Continued tracking of these data beyond this initial 2-year foundation will provide a valuable internal benchmark to compare against available data and with institutional/national metrics of quality of care at the department and individual surgeon level.