M&M outline detail complications, questions

Below is a typical M&M Matrix from Cedars Sinai Medical Center in Los Angeles. The outline is complication-oriented, each topic beginning with an analysis of the complication.

The subheadings are particular areas discussed at the conference, such as points made and questions raised. This outline is the basis of the yearlong complication-oriented curriculum:

The M&M Matrix for April 18, 2002 Surgical Morbidity and Mortality Conference Cedars-Sinai Medical Center

Six matrices were developed at the Surgical Morbidity and Mortality Conference of April 18, 2002:

1. Peritracheal bleeding

A. Surgical anatomy of the peritracheal area

B. Operative causes of bleeding

C. Immediate postoperative causes of bleeding

D. Delayed bleeding; the Herald bleed

E. Preoperative workup for peritracheal bleeding

2. Tracheostomy techniques

A. Percutaneous methods

B. Open tracheostomy

C. Relative morbidity and mortality of each technique; bleeding

D. Long-term complications of tracheostomy; stenosis

3. Tracheo-innominate fistulae

A. Incidence

B. Presentation

C. Causes

D. Operative management; approaches

4. Colocutaneous fistulae

A. Management

B. Etiologies; ischemia, enterotomy, drain erosion

C. Likely causes during mobilization for a colostomy

5. Drains

A. Types

B. Management of the sump drain

C. The global view, or "What am I draining, and what is the risk of manipulating this drain?"

D. Histological findings resulting from 40 cm Hg wall suction; pathology-surgical correlation

6. Exigent stomal bleeding

A. Workup

B. Role of colonoscopy

C. Risks of colonoscopy

D. Pseudo-aneurysms of colonic vasculature

E. Role of the red cell-labeled scan or "The Parallel Universe of Gastrointestinal Bleeding."

F. Surgical complications of stomal creation

G. Role of angiography; diagnosis, embolization