An Eight-Year Analysis of Surgical Morbidity and Mortality: Data and Solutions

2006 ◽  
Vol 72 (11) ◽  
pp. 1070-1081
Author(s):  
Michael A. Goldfarb ◽  
Thomas Baker
Keyword(s):  
Surgical Outcome ◽  
Medical Center ◽  
Morbidity And Mortality ◽  
Mortality Data ◽  
Time Process ◽  
Operative Techniques ◽  
Barriers To Adoption ◽  
Surgical Morbidity ◽  
Technical Complications ◽  
Common Problems

In this article, a reproducible process for presenting, analyzing, and reducing early and late surgical morbidity and mortality (M&M) is detailed. All M&M cases presented from 1998 through 2005 at Monmouth Medical Center were categorized. Residents and nurses were empowered to report the complications. The five major categories were overwhelming disease on admission, delays in treatment, diagnostic or judgment complications, treatment complications, and technical complications. From the 53,541 operations performed over 8 years, 714 patients were presented, which included 147 deaths and 1,132 category entries. The most common problems were technical complications in 474 (66.4%) patients. The data have generated actionable solutions, many with low barriers to adoption, resulting in safer, less expensive surgical management. Surgical outcome benchmarks have been established and are used for credentialing surgeons. The “Hostile Abdomen Index” has been developed to assess the safest choice for abdominal operative access, pre- and intraoperatively. We explained the real-time process that generated solutions for the entire department as well as changes relevant to residency training and individual operative techniques.

scholarly journals Spatial analysis of risk of morbidity and mortality by COVID-19 in Europe and the Mediterranean in the year 2020

2020 ◽  
Vol 60 (1) ◽  
Author(s):  
Jesús Enrique Andrades-Grassi ◽  
Ledyz Cuesta-Herrera ◽  
Guillermo Bianchi-Pérez ◽  
Hilda Cristina Grassi ◽  
Juan Ygnacio López-Hernández ◽  
...  
Keyword(s):  
Spatial Analysis ◽  
Morbidity And Mortality ◽  
Mortality Data ◽  
Time Process ◽  
Gamma Model ◽  
Risk Models ◽  
Mortality Process ◽  
Spatial Risk ◽  
The Mediterranean ◽  
The Individual

Disease mapping seeks to represent the risk of a disease. This paper focuses on the spatial analysis of risk for pandemic COVID-19 in Europe and the Mediterranean. Morbidity and mortality data for 54 countries in ratio format were used. Two hypotheses were considered, the first one is that the data are homogeneous and the second one is that the ratios are defined in a heterogeneous manner requiring the stratification on the basis of covariables and the methodology of Jenks’ intervals. Spatial risk models were applied as well as methods for the representation of clusters. The results show that the best representation is obtained with the Poisson-Gamma Model under stratification. The variations in the ratios are due to the individual policies of each country for the management of the pandemic. The cluster analysis shows that there is a high mortality process in Eastern Europe. The behavior of the pandemic should be evaluated in the space-time process as well as in other heterogeneous and highly unequal regions.

Abstract 147: Hypertension-related Admission and Mortality at a Referral Hospital in Tanzania - A Call to Action

Hypertension ◽  
2012 ◽  
Vol 60 (suppl_1) ◽  
Author(s):  
Naomi Shike ◽  
Santosh Vardhana ◽  
Judith Briant ◽  
Robert Peck
Keyword(s):  
Heart Failure ◽  
Medical Center ◽  
Tertiary Care ◽  
Sub Saharan Africa ◽  
Morbidity And Mortality ◽  
Hospital Death ◽  
Care Hospital ◽  
Common Cause ◽  
Related Disease ◽  
Reasonable Approach

Introduction The WHO has been increasingly emphasizing and calling for research on the vast unattended burden of non-communicable diseases in the developing world. Hypertension (HTN) in particular is thought to play a growing role in morbidity and mortality in these regions, but has yet to gain significant momentum in public health initiatives. Objective To determine what role HTN and comorbid diseases play in admission and mortality in Bugando Medical Center (BMC), a tertiary care hospital in Tanzania serving 13 million people. Methods We conducted a retrospective analysis of all patients admitted to the internal medicine service at BMC over 34 months between 2008 and 2011. Data on admission diagnoses and mortality had been collected prospectively by Tanzanian doctors in hand-written logs. For patients with heart failure or stroke, the ward logs specified if this was primarily related to hypertension or other risk factors. Data were copied into an Excel database and analyzed to determine the proportion of admissions and deaths primarily related to hypertension. Results In 34 months 8,037 patients were admitted and 1,508 died. HTN-related disease led to 1,997 admissions (25%), while HIV-related illness led to 2,076 (26%). Similarly, HTN led to 377 deaths (25%) and HIV to 579 (38%). HTN-related disease was second only to HIV-related disease as a cause of admission and death. Among hypertensives, the most common cause of admission was congestive heart failure (446; 27%) and of death was stroke (147; 49%). In non-hypertensives, HIV-related disease was the most common cause of both admission (2029; 32%) and death (566; 46%). Conclusions HTN-related disease was second only to HIV as a cause of admission to our hospital and in-hospital death. Better strategies for early diagnosis and treatment of HTN are desperately need in sub Saharan Africa to prevent this morbidity and mortality. Building HTN screening and treatment on top of the extensive infrastructure for HIV disease may be a reasonable approach.

News and Announcements

PEDIATRICS ◽  
1974 ◽  
Vol 53 (6) ◽  
pp. 955-955
Keyword(s):  
Annual Meeting ◽  
International Society ◽  
Medical Center ◽  
Pediatric Gastroenterology ◽  
University Of Minnesota ◽  
School Of Medicine ◽  
Common Problems ◽  
Sick Children ◽  
Nutrition Diagnosis ◽  
Vanderbilt University

PAEDIATIC NEUROSURGERY: The International Society for Paediatric Neurosurgery, annual meeting, London, England, September 13-14. For information write Kenneth Till, The Hospital for Sick Children, Great Ormond Street, London WC IN 3JH, England. PEDIATRIC GASTROENTEROLOCY AND NUTRITION: The Children's Hospital of Vanderbilt University, Fifth Annual Autumn Pediatric Symposium on Pediatric Gastroenterology and Nutrition-Diagnosis and Management of Common Problems, September 20-21. Guest faculty: Dr. William Schubert, Department of Pediatrics, University of Cincinnati School of Medicine; Dr. Phil Sunshine, Department of Pediatrics, Stanford University Medical Center; and Dr. Harvey Sharp, Department of Pediatrics, University of Minnesota Medical Center. For information write Harry L. Greene, M.D., Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee 37232.

scholarly journals Outcomes of Craniofacial Open Surgery in Octogenarians

2018 ◽  
Vol 79 (06) ◽  
pp. 515-521
Author(s):  
Barak Ringel ◽  
Narin Carmel-Neiderman ◽  
Daniel Ben-Ner ◽  
Aviyah Pery ◽  
Ahmad Safadi ◽  
...  
Keyword(s):  
Skull Base ◽  
Skull Base Surgery ◽  
Medical Center ◽  
Morbidity And Mortality ◽  
Wound Complications ◽  
Steady Increase ◽  
Systemic Complications ◽  
Female Ratio ◽  
Younger Patients ◽  
Surgery In Octogenarians

Introduction The steady increase in average life expectancy has led to a rise in the number of referrals of elderly patients for major operations. It is not clear whether age itself is a risk factor for morbidity and mortality after skull base operations. We investigated a possible link among a cohort of patients older than 80 years of age who underwent those surgeries in our department. Methods We conducted a retrospective analysis of all patients who underwent skull base surgery at the TASMC (Tel Aviv Sourasky Medical Center) between 2000 and 2016. Results A total of 369 patients underwent open skull base surgeries in our institution, and 13 were patients older than 80 years. The median age of the octogenarians was 83.4 (range 80–89), and the male-to-female ratio was 7:6. Twelve patients had major systemic comorbidities. Four patients had major complications associated with surgery: three had early wound complications, and one each had early central nervous system complications, early and late systemic complications, and late orbital complications. This complication rate is comparable to that of our younger group of 356 patients. The overall survival rate was measured for 30 days, 1 year, and 3 years, and it was not significantly different between the octogenarians and that of the younger patients. Further comparison of the elderly group with 13 matched younger patients revealed no difference of morbidity and mortality between the two groups. Conclusions Despite their systemic comorbidities, the morbidity and mortality rates associated with skull base surgery in octogenarians appear to be comparable to that of younger patients undergoing the same procedures.

scholarly journals An unusual presentation of Gossypiboma associated with secondary infertility: a case report

2021 ◽  
Vol 10 (8) ◽  
pp. 3236
Author(s):  
Eshwarya J. Kaur ◽  
Ganesh Saravagi
Keyword(s):  
Case Report ◽  
Unusual Case ◽  
Adnexal Mass ◽  
Perioperative Period ◽  
Definitive Diagnosis ◽  
Unusual Presentation ◽  
Morbidity And Mortality ◽  
Surgical Morbidity ◽  
Secondary Infertility ◽  
Abdominal Complications

Gossypibomas are a rare cause of surgical morbidity and mortality. When unrecognised in the perioperative period, they can present later with a myriad of abdominal complications. We present an unusual case of gossypiboma that was discovered as a cause of secondary infertility, misdiagnosed as a complex adnexal mass. After a definitive diagnosis was made, the removal of gossypiboma restored fertility in the patient successfully.

Lessons Learned From the Surgical Morbidity and Mortality Conference

2019 ◽  
Vol 76 (1) ◽  
pp. 174-181 ◽  
Author(s):  
Kaio S. Ferreira ◽  
Kenneth Lynch ◽  
Beth A. Ryder ◽  
Michael Connolly ◽  
Thomas Miner ◽  
...  
Keyword(s):  
Lessons Learned ◽  
Morbidity And Mortality ◽  
Surgical Morbidity ◽  
Morbidity And Mortality Conference ◽  
Mortality Conference

Defining a new neurosurgical complication classification: lessons learned from a monthly Morbidity and Mortality conference

2020 ◽  
Vol 132 (1) ◽  
pp. 272-276 ◽  
Author(s):  
Yair M. Gozal ◽  
Erinç Aktüre ◽  
Vijay M. Ravindra ◽  
Jonathan P. Scoville ◽  
Randy L. Jensen ◽  
...  
Keyword(s):  
Adverse Events ◽  
Classification System ◽  
Medical Center ◽  
Classification Systems ◽  
Morbidity And Mortality ◽  
Neurosurgical Procedures ◽  
Critical Events ◽  
Technical Errors ◽  
Morbidity And Mortality Conference ◽  
Mortality Conference

OBJECTIVEThe absence of a commonly accepted standardized classification system for complication reporting confounds the recognition, objective reporting, management, and avoidance of perioperative adverse events. In the past decade, several classification systems have been proposed for use in neurosurgery, but these generally focus on tallying specific complications and grading their effect on patient morbidity. Herein, the authors propose and prospectively validate a new neurosurgical complication classification based on understanding the underlying causes of the adverse events.METHODSA new complication classification system was devised based on the authors’ previous work on morbidity in endovascular surgery. Adverse events were prospectively compiled for all neurosurgical procedures performed at their tertiary care academic medical center over the course of 1 year into 5 subgroups: 1) indication errors; 2) procedural errors; 3) technical errors; 4) judgment errors; and 5) critical events. The complications were presented at the monthly institutional Morbidity and Mortality conference where, following extensive discussion, they were assigned to one of the 5 subgroups. Additional subgroup analyses by neurosurgical subspecialty were also performed.RESULTSA total of 115 neurosurgical complications were observed and analyzed during the study period. Of these, nearly half were critical events, while technical errors accounted for approximately one-third of all complications. Within neurosurgical subspecialties, vascular neurosurgery (36.5%) had the most complications, followed by spine & peripheral nerve (21.7%), neuro-oncology (14.8%), cranial trauma (13.9%), general neurosurgery (12.2%), and functional neurosurgery (0.9%).CONCLUSIONSThe authors’ novel neurosurgical complication classification system was successfully implemented in a prospective manner at their high-volume tertiary medical center. By employing the well-established Morbidity and Mortality conference mechanism, this simple system may be easily applied at other neurosurgical centers and may allow for uniform analyses of perioperative morbidity and the introduction of corrective initiatives.

scholarly journals Emergency subtotal colectomy for fulminant Clostridium difficile colitis – is a surgical solution considered for all patients?

2010 ◽  
Vol 92 (1) ◽  
pp. 56-60 ◽  
Author(s):  
K Gash ◽  
E Brown ◽  
A Pullyblank
Keyword(s):  
Clostridium Difficile ◽  
Subtotal Colectomy ◽  
Postoperative Mortality ◽  
Antibiotic Use ◽  
Morbidity And Mortality ◽  
Fulminant Colitis ◽  
Surgical Morbidity ◽  
Predisposing Factor ◽  
Number Of Patients ◽  
Neurosurgical Patients

INTRODUCTION Clostridium difficile has been an increasing problem in UK hospitals. At the time of this study, there was a high incidence of C. difficile within our trust and a number of patients developed acute fulminant colitis requiring subtotal colectomy. We review a series of colectomies for C. difficile, examining the associated morbidity and mortality and the factors that predispose to acute fulminant colitis. PATIENTS AND METHODS This is a retrospective study of patients undergoing subtotal colectomy for C. difficile colitis in an NHS trust over 18 months. Case notes were reviewed for antibiotic use, duration of diarrhoea, treatment, blood results, pre-operative imaging and surgical morbidity and mortality. RESULTS A total of 1398 patients tested positive for C. difficile in this period. Of these, 18 (1.29%) underwent colectomy. All were emergency admissions, 35% medical, 35% surgical, 24% neurosurgical and 6% orthopaedic. In the cohort, 29% were aged less than 65 years. Patients had a median of three antibiotics (range, 1–6), for a median of 10 days (range, 0–59 days). Median length of stay prior to C. difficile diagnosis was 13 days. Subtotal colectomy was performed a median of 4 days (range, 0–23 days) after diagnosis. Postoperative mortality was 53% (9 of 17). The median C-reactive protein level for those who died was 302 mg/l, in contrast to 214 mg/l in the survival group. Whilst 62% of all C. difficile cases were medical, the colectomy rate was only 0.7%. In the surgical specialties, the colectomy rates were 3.2% for general surgical, 1.2% for orthopaedic and 8% for neurosurgical patients. CONCLUSIONS Colectomy for C. difficile colitis has a high mortality but can be life-saving, even in extremely sick patients. Although heavy antibiotic use is a predisposing factor, this is not an obligatory prerequisite in the development of C. difficile. Neither is it a disease of the elderly, making it difficult to predict vulnerable patients. There are large differences in colectomy rates between specialties and we suggest there may be a place for a surgical opinion in all cases of severe C. difficile colitis.

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