Unique Neurosurgical Morbidity and Mortality Conference Characteristics: A Comprehensive Literature Review of Neurosurgical Morbidity and Mortality Conference Practices with Proposed Recommendations

OBJECTIVE: The aim of the present study was to review the reported data for neurosurgical complication definitions, report the current scales used to classify these complications, and discuss their limitations. METHODS: A systematic review was performed through a PubMed search using predetermined MeSH terms and inclusion criteria. Studies meeting the inclusion criteria were specific to the field of neurosurgery and had presented a unique complication grading scale. RESULTS: A total of 2156 PubMed results matched our predetermined MeSH terms. Of those, 7 met our inclusion criteria. These 7 studies were reported from 2001 to 2019. Of the 7 studies, 4 were applicable to general neurosurgery, 2 to spine surgery, and 1 to neuroendovascular surgery. The scales were based on the therapy needed, predictability and avoidability, survey/consensus of expert judgment, and the underlying cause of an adverse event. None of these studies had considered the complexity of the surgery or the frailty of the patient in the final grading score. CONCLUSIONS: No current standardized neurosurgical complication grade has been used throughout morbidity and mortality conferences. Although scales have been proposed in reported studies, each with their strengths and limitations, none of these has considered surgery complexity or patient frailty and comorbidities. We believe a comprehensive scale is required that includes a preoperative grading system that factors in baseline surgical complexity and patient frailty