Determining Surgical Complications in the Overweight

Clinical Audit Report:

Determining Surgical Complications in the overweight

(DISCOVER)

(TEMPLATE)

Hospital/Centre:

Supervising Consultant:

Data Collection Team:

Data Collection Period:

How to use this template

1. Reporting back of audit results to key stakeholders including audit departments is good practice.
2. This may be done in several ways, including presenting your results in an oral presentation at an audit meeting or departmental meeting. Alternatively your local audit department may require that you submit a written report of the results.
3. This template is designed to aid you in reporting the results of DISCOVERin written form to your audit department. Note that your audit department may have their own template for these reports or may require further information not covered in this template. In all instances, seek your department’s guidance on this.
4. All members of the data collection team and the supervising consultant should approve of the report before submission to audit departments.
5. Feel free to format report and add sections as required.
6. Guidance notes on this template are in red font- delete them before submission.

1.STARSurgand DISCOVER

Student Audit and Research in Surgery (STARSurg) is a national student-led collaborative facilitating multi-centre audit and service evaluations. STARSurg is co-ordinated by a steering group of medical students and surgical trainees. It is represented locally by a network of medical student and junior doctor collaborators covering all medical schools in the UK and the Republic of Ireland.

Obesity has reached epidemic levels worldwide. In UK surgical practice, 30% of surgical patients are obese. There is conflicting evidence on the impact of obesity on post-operative complications after gastrointestinal surgery.

Currently, to ensure patients receive appropriate care, guidelines from the National Institute for Health and Care Excellence recommend that all patients being admitted into hospital undergo a calculation of their Body Mass Index (BMI).

DISCOVER aims to audit compliance with NICE guidelines on BMI measurement and establish whether obesity is associated with an increased risk of post-operative complications in patients undergoing gastrointestinal surgery

A full protocol including supporting documents detailing the conduct of DISCOVER is available online for download at

2.Aims and Objectives of audit

(i)To establish compliance with NICE guidelines requiring early identification of obese patients.

(ii) To benchmark obese surgical patients’ outcomes against accepted international standards, determining the role of obesity as a risk factor for major post-operative complications in current UK and Irish practice.

3.Audit Standards and Criteria

(ii)All patients should have body mass index (BMI) calculated on admission to hospital.

(iii)Compared to non-obese patients, obese patients should not be at increased risk of major post-operative complications.

This standard is based on the landmark Lancet study of over six thousand patients by Dindo et al., which found that the incidence of complications did not differ between obese and non-obese patients4.

4.Methodology

Summary

Teams supervised by a consultant surgeon, comprising medical students and junior doctors, prospectively collected data on consecutive patients undergoing gastrointestinal or hepatobiliary surgery over a 14-day period.

Project Timeline

The overall data collection period was Wednesday 1stOctober to Wednesday 29th October 2014. The mini-team collected data over two 14-day, consecutive periods.

(DELETE as appropriate)

Period 1: 0800 Wednesday 1stOct to 0759 Wednesday 15thOct.

Period 2: 0800 Wednesday 15thOct to 0759 Wednesday 29thOct.

Period 3: 0800 Wed 29th Oct to 0759 Wed 12th Nov.

Strategies to identify consecutive patients included:

• Daily review of elective theatre lists.
• Daily review of handover sheets/emergency admission and ward lists.
• Daily review of theatre logbooks(both elective and emergency).

Inclusion criteria

Summary: All adult patients with an overnight stay in hospital, undergoing gastrointestinal surgery (surgery on the oesophagus, stomach, small and large bowel, rectum and anus), bariatric surgery or hepatobiliary surgery (surgery on the liver, pancreas, gallbladder and biliary tree)

Age: 18 years or above

Timing: Elective or emergency procedures

Length of stay: Patients with an overnight stay, either preceding or following the operation

Technique: Open, laparoscopic, laparoscopically-assisted, or laparoscopic-converted to open procedures

Included procedures:

• Surgery on the gastrointestinal tract from the oesophagus to the rectum and anus.
• Surgery on the liver, biliary tree, gallbladder and pancreas.

Excluded procedures:

• Day case surgery
• Minor anorectal surgery
  e.g. surgery on haemorrhoids, rectal prolapse, fistula – unless there was an abdominal incision or the procedure was laparoscopic
• Hernia surgery
  Not included unless the procedure required either small bowel or colonic resection.
• Transplant surgery
• Urological indication
  e.g. ileal conduit.
• Gynaecological indication
• Vascular indication
  e.g. open AAA repair.
• Trauma indication
  e.g. trauma laparotomy.
• Interventional radiology
  e.g. CT-guided placement of a drain.
• Diagnostic procedures
  e.g. diagnostic/ staging laparoscopy or laparotomy, endoscopic procedures (e.g. oesophago-gastro duodenoscopy (OGD) or colonoscopy), examination under anaesthetic of the rectum except appendectomies

Page | 1

5.Results

(Enter/copy data and/or graphs from the DISCOVER Analysis Sheet Tool into the relevant sections)

Section 1: Demographics

Section 2: Operative details

Section 3: Outcome details

Section 4: Audit Standard Adherence

Section 5: Risk of Operative Complications

Page | 1