Improving the quality of operation notes: Effect of using proforma, audit and education sessions

WOS: 000544899000006PubMed: 31653554Background: Both from a medical and legal point of view, the quality of operative notes are important. in this study we hypothesized that the quality of operation notes could be improved by audit, education session and using a proforma. Methods: A total of 150 operation notes were audited for compliance with the Royal College of Surgeons guidelines. Results were announced in -clinic training session and guidelines were dis- cussed. An aide-memoire containing guideline parameters placed in the operating theaters. After eight months, operation reports were re -audited on an equal number of patients. An operative note proforma was developed and third audit was carried out. the results of each audit were compared. Results: in the first audit, it was found that fourteen parameters were written with more than 90% accuracy. the first audit revealed seven poor areas in documentation: time of operation (0%), identification of emergency/elective procedure (0%), identification of any prosthesis or devices used (65.3%), details of closure technique (36.6%), name of anesthesiologist (0%), pa- tient position (1.3%), and amount of bleeding (0%). in the second audit there was an incom- plete, but significant improvement in these seven parameters (28%, 28.6%, 82%, 75.3%, 31.3%, 32%, and 34% respectively). Following introduction of the proforma; third audit cycle demonstrated a clear improvement in operation note documentation with at least 80% compli- ance in all parameters. Conclusion: This study revealed that the accuracy of the operating room documents can be improved through audits, education of surgeon and using proformas. the use of proforma pro- vides much better results. (C) 2019 Asian Surgical Association and Taiwan Robotic Surgery Association. Publishing services by Elsevier B. V. This is an open access article under the CC BY-NC- ND license (http:// creativecommons.org/licenses/by-nc-nd/4.0/)

Functional outcomes of intersphincteric resection in low rectal tumors

Objective: Currently, sphincter-saving procedures are increasingly performed in the treatment of low rectal cancers. This study aimed to evaluate the outcomes of patients who underwent intersphincteric resection. Material and Methods: This was a single-center, retrospective, cross-sectional study. We evaluated the electronic data files of 29 patients who had intersphincteric resections at our institute between 2008 and 2018. Bowel function outcomes were assessed prospectively using Wexner incontinence score. Histopathological, surgical and functional outcomes were analyzed. Results: Mean age of nine female and 20 male patients included in the study was 55.8 +/- 12.8 (30-76) years. A tumor-free surgical margin was achieved in all patients. Anastomotic leakage was detected in two patients. Mean Wexner incontinence score of 20 patients who still had functional anastomosis was 8.35, whereas 65% of the patients (n= 13) had a good continence status. There was no relationship between the continence status and sex, tumor distance from anal verge, T stage, distal surgical margin, and lymph node involvement. Twenty-one patients underwent primary coloanal anastomosis and eight patients underwent two-stage coloanal anastomosis. Conclusion: In the treatment of distal rectal cancer, adequate oncological surgery and relatively acceptable functional outcomes can be obtained with intersphincteric resection technique in suitable patients