Morbidity meetings: what makes it to; what stays out of the forum.

OBJECTIVES: To review the utility of morbidity and mortality forum in General Surgery at a tertiary care hospital in Karachi, Pakistan. METHODS: The retrospective study was conducted at the Aga Khan University Hospital and reviewed morbidity data from March to May 2009. Case notes of all patients admitted to the General Surgical service during the study period were reviewed to identify in-hospital morbidities. RESULTS: There were a total of 340 inpatients during this period. Case notes identified 61 (17.94%) patients with morbidities; 35 (57.37%) males and 26 (42.62%) females. The morbidity record for the same period identified 32 (52.5%) patients, while 29 (47.5%) morbidities were missed. Of the total morbidities, 32 (52.5%) patients were admitted to the general ward, and 29 (47.5%) to high dependency areas. Nine (28%) morbidities identified in the general ward, and 23 (79%) in high dependency areas were formally presented. Morbidities related to the abdominal cavity were the commonest (n = 22; 36%). Wound-related (n = 17; 28%) and cardio-pulmonary (n = 8; 13%) complication were the next most frequent. CONCLUSIONS: Abdominal cavity morbidities were the most common in this review followed by wound related and cardiopulmonary complications. The morbidity and mortality forum is an educational activity that has stood the test of time and continues to be the cornerstone of post-graduate education. It should be considered a mandatory activity in all postgraduate training programmes.

An evidence-based review of the current treatment of congenital diaphragmatic hernia.

Congenital diaphragmatic hernia is a rare but severe condition affecting 1 in 2000 to 3000 newborns with a survival rate of 67%. Although regular antenatal screening allows prenatal diagnosis in many cases, traditionally treatment has been based on postnatal surgical repair. Recent literature has pointed out the survival benefits of initial stabilization and the use of gentle ventilation strategies prior to definitive treatment, shifting the trend from immediate to delayed surgical repair. Advances in fetal intervention have allowed the introduction of fetal endoscopic tracheal occlusion as a method to hasten lung development before birth in order to minimize postnatal morbidity. Despite appropriate treatment, the long-term outcomes of these patients are plagued with numerous complications, associated with the primary pathology and also aggressive therapeutic measures. International centers of excellence have recently come together in an effort to standardize the care of such patients in hopes of maximizing their outcomes.