This study aimed to assess the impact of routine M&MC on the preventable death rate over 4 years. Before the study period, M&MC was not routinely conducted in our department, and there was no electronic registry dedicated to surgical quality assurance.

We observed a statistically significant decrease in preventable death rates over 4 years. The preventable mortality rate decreased by approximately 50%, from 36.6% to 18.2% for all mortalities. We note that in the first year of 2016, data were collected only for the second half of the year, from July to December, and may not have been representative. However, the decreasing trend in preventable mortality rates was maintained over the subsequent 3 years. While we acknowledge that some confounders may underlie the findings of the reduction in preventable mortality rate, the results are compelling and suggest that routine M&MC played a significant role. The literature indicates that prospective and continuous data collection on avoidable deaths and identification of errors ultimately directs and informs practice toward improved outcomes [11, 12].

During the M&MC, the department endeavored to create a conducive learning environment and ensured that remedial action was clearly communicated. Residents and medical officers independently documented mortalities and presented them to the department. The input of surgeons was greater during discussions. Discussions of cases addressed principles rather than individuals. As a result, we believe that we foster a conducive learning environment and minimize the tendency to underreport mortality.

In this study, trauma was the leading cause of avoidable deaths. This finding is in keeping with previous studies conducted locally, showing trauma as the most common acute presentation and head injury as a significant public concern among young men in the country [13,14,15]. In total, 68.2% of road traffic collision deaths in our country are considered preventable [16]. Trauma is the leading cause of death both globally and among young people. However, its impact is disproportionately significant in low- and middle-income countries [16, 17], including locally. High rates of trauma-related preventable deaths indicate the need for a comprehensive trauma system [15, 16, 18]. Trauma kills by predictable mechanisms and time frames, and comprehensive trauma systems improve the outcomes of injured patients [19, 20].

Although the diagnoses were variable, the causes of preventable deaths were the same, with septic shock being the most common one. It was also noted that the reduction in the preventable death rates over the 4 years was attributable mainly to the reduction in the rate of septic shock as the cause. The authors believe that interventions implemented in response to the discussion might have had a role in this reduction. Some of the interventions were: implementing a formal handover checklist, especially for very sick patients, weekly presentations on select topics, and daily presentations of new mortalities at morning meetings.

The authors acknowledge the limitations of this study. There is potential for under-reporting mortalities. However, the department holds daily morning meetings during which mortalities are reported by the on-call team, making it easy for the department to notice if a case is omitted at the monthly M&MC. There has been an increase in the number of subspecialty services in the private sector compared to the public sector. This has led to increasing subspecialty cases being transferred to the private sector under government cover. This may result in diverting mortalities to the private sector or reducing preventable deaths due to the specialized care provided in the private sector. The findings of this study provide a starting point for further investigation of the impact of M&MC on preventable death rates.