Anonymous group peer review in surgery morbidity and mortality conference

Background: Surgical peer review might be characterized by assessment heterogeneity. Methods: We performed a prospective, anonymous, peer review of surgeon and system performance during a morbidity and mortality conference. Results: Twenty-two cases were reviewed by a mean of 48.9 respondents each, including attendings, fellows, and residents. A mean of 50% (standard deviation, 23%) of respondents identified some quality issue in each case, reflecting high heterogeneity. The mean percentage in identifying a system issue was 27%, and in identifying a physician issue was 37%. When identifying a physician issue, physician care was judged as appropriate by 72%, as controversial by 26%, or as inappropriate by 2%. Residents were more likely than attendings to identify system issues (odds ratio, 2.23) and physician issues (odds ratio, 3.58), but attendings were more likely to rate care controversial or inappropriate (odds ratio, 2.53). Conclusions: Surgical peer reviews, even after group discussion, display substantial heterogeneity. Review methods should account for this heterogeneity.