Proposed clinical operative synoptic report for ileocolic resection for Crohn's disease

BACKGROUND

Crohn's disease patients may require multiple surgeries during their lifetime. Because operative reports are not standardized, information relevant to future management may not be documented. Synoptic reports used in other fields such as histopathology have proven to be effective and allow consistent documentation of results. The aim of this study was to retrospectively review the completeness of the operative reports for ileocolic Crohn's resections (ICR) and to propose a synoptic report.

METHODS

A draft synoptic operative report for ICR for Crohn's disease was presented in the IBD multidisciplinary meeting and a Delphi process used to gain consensus for inclusion in the synoptic report. Retrospective analysis of consecutive ICR from January 2010 to April 2023 was undertaken to determine the presence of the standardized criteria.

RESULTS

A total of 66 ICR were performed in 63 patients during the study period. No operation reports were excluded. The examination of bowel for macroscopic disease was partially documented in 88% cases. The extent of mesenteric resection and any difficulty encountered during dissection were poorly documented. The remaining length of small and large intestines was not documented in most operative reports. The clinical sections that were compulsory entrance in the electronic operative report achieved 100% compliance.

CONCLUSION

This study has demonstrated that key information was often deficient in the operative report. This may have a significant impact on the future management of Crohn's patients and affects the interpretation of research outcomes. A proposed clinical synoptic operative report is easy to use and ensures compliance.

Parotid gland pleomorphic adenoma re-operations with regard to patient and surgeon satisfaction: what can be improved?

BACKGROUND

Surgery, the treatment of choice for parotid pleomorphic adenoma (PA), is associated with facial nerve palsy and decreased quality of life. Re-operation for PA recurrence (rPA) significantly increases these risks and constitutes a dilemma for both patient and surgeon. Factors influencing the success of re-operation, as well as the self-reported satisfaction of both sides, have yet to be addressed in the literature. This study aims to improve upon the decision-making schedule in PA re-operations, based on patient expectations, imaging, and concordance with the first operative report (FOpR).

METHODS

Seventy-two rPAs treated in a single tertiary center were collected and analyzed. The FOpRs and pre-operative imaging were divided according to defined criteria into accurate and non-accurate categories. The re-operative field and course were categorized as anticipated or unanticipated. The re-operation was categorized as satisfactory or unsatisfactory for both the patient and the surgeon.

RESULTS

The accuracy of FOpRs and pre-operative imaging was 36.1% and 69.4%, respectively. Re-operative courses were: 36.1% anticipated and 63.9% unanticipated. The most frequently omitted data were: presence of satellite tumors (9.7%), and amount of removed parenchyma (9.7%). Variables that most commonly affected FOpR non-accuracy were: tumor size (Chi2(1)=59.92; p < 0.001) and capsule condition (Chi2(1)=29.11; p < 0.001). There was no significant relationship between FOpR accuracy and re-operative course (Chi2(1)=1.14; p = 0.286), patient satisfaction (Chi2(1)=1.94; p = 0.164) or surgeon satisfaction (Chi2(1)=0.04; p = 0.837). Pre-operative imaging (Chi2(1)=36.73; p < 0.001) had the greatest impact on surgeon satisfaction.

CONCLUSION

Accurate pre-operative imaging impacted surgeon satisfaction. The impact of the FOpR on re-operation technicalities and patient satisfaction was minor. Imaging precision should be improved to streamline the decision-making process of PA re-operation. This article proposes suggestions for a future decision-making algorithm as a starting point for a prospective study.Key messagesAccurate pre-operative imaging impacts both surgeon and patient satisfaction.There is no significant relationship between the accuracy of the first operative report and surgeon and patient satisfaction.There is a statistically significant relationship between patient and surgeon satisfaction.

Is synoptic operative reporting necessary for Crohn's disease surgery? Variability in surgical reports across inflammatory bowel disease referral centres

AIM

Ileocolic resection (ICR) is the most commonly performed operation in Crohn's disease (CD) patients. The surgical report is a vital tool for accessing information to gauge a patient's long-term prognosis and guide treatment decisions. Dictated narrative reports are the traditional method for surgical documentation but often lack essential information. The objective was to assess the quality of operation note in CD patients undergoing ICR.

METHOD

This was a multi-institutional retrospective cohort collaborative study involving four tertiary inflammatory bowel disease referral centres in the USA and Canada. The patients were consecutive CD patients undergoing ICR between 2014 and 2020. There were no interventions. The main outcome measures were the variability and frequency of 28 critical items in the operation note.

RESULTS

An analysis of 400 consecutive operation reports in four institutions (n = 100/institution) revealed significant variability in almost all variables. The initial surgical approach and wound protector use were the most consistently or frequently reported across all inflammatory bowel disease centres. The limitation was that this was a retrospective cohort study with inevitable selection bias.

CONCLUSIONS

This study highlights the need for synoptic reporting in CD patients undergoing ICR.

Percutaneous Thoracic Spinal Cord Stimulator Placement

Spinal cord stimulation is a safe, effective, and reversible method for the management of chronic neuropathic pain. Spinal cord stimulation was found to be superior to traditional conservative management in recent clinical trials. The superiority of this therapeutic strategy is in part due to the many benefits, such as decreased use of prescription pain medications, cost-effectiveness, and improvement in patient quality of life. With appropriate patient consent for photography during the operation per hospital policy, the technical description for percutaneous placement of a spinal cord stimulator was documented at the authors home institution. The percutaneous technique allows for decreased operative times and thus reduced anesthesia, as well as decreased post-operative pain due to less tissue and muscle dissection. Additionally, the percutaneous leads have a smaller footprint in the epidural space, allowing more patients with mild spinal canal stenosis to receive this therapeutic device, which generally precludes paddle placement. These features make the percutaneous method an appealing alternative to the traditional laminotomy technique. The traditional laminotomy approach for paddle lead placement has been well described in the literature. However, detailed and indexed techniques of the percutaneous alternative are lacking. This technical description provides the first, easily accessible technical guide for the percutaneous placement of thoracic spinal cord stimulators. The operative technique was documented with images and detailed descriptions at the authors home institution.

Evaluating narrative operative reports for endoscopic sinus surgery in a residency training program

Objective

The narrative operative report (NR) bears testimony to critical elements of patient care. Residents’ NRs also provide insights into their comprehension of the procedure. NR documentation is an informal element of surgical residency training but data regarding quality of such training are scant. We aim to evaluate the NR within a residency training program.

Methods

The quality of NRs for endoscopic sinus surgery (ESS) was evaluated through a retrospective analysis of 90 NRs for ESS. Thirty‐four elements that the attending surgeon regards as “critical” variables, or quality indicators (QIs), that should be documented, were studied to evaluate quality. A “performance metric (PM),” defined as the average percent of QIs dictated/total word count, was determined. Subgroup analysis by the level of training was additionally performed.

Results

Surgical indications, procedural steps, and immediate postoperative findings were accurately documented in 71%, 84%, and 82% of patients, respectively. The attending surgeon had the highest proportion of included key elements (89% ± 6.2%) followed by junior residents (87% ± 5.7%) and then senior residents (80% ± 14%) (P = .008). The attending surgeon also demonstrated the highest PM, followed by senior and then junior residents (P < .0001).

Conclusions

The quality of NRs was found to be high overall, but not “perfect” for either the attending or trainee surgeon. The PM among residents was expectedly lower than the attending surgeon. We propose that a synoptic reporting system that ensures inclusion of key elements may be helpful in training residents (and attendings) in creating comprehensive and efficient NRs.

Level of Evidence

3