Background

Ziv medical center is a 350 bed rural hospital, affiliated to Bar- Ilan Faculty of Medicine. It serves the population of upper Galilee and the Golan and includes all surgical specialties except neurosurgery and cardiothoracic surgery. Advanced laparoscopic surgery is instituted at our department since 2014.

Recording complications of each procedure is of paramount importance for continuous improvement in clinical care on surgical wards worldwide. This is reflected in our department in the weekly “Morbidity & Mortality” meeting.

Retrospective collection of data may lead to inaccurate or only partial detail that results in missed findings and leads to poor academic rigor in clinical practice, audit and research. We designed a friendly computerized interface for the real time prospective recording of surgical complications.

The Form

All-In-One unique page form as been developed for data collection Figure 1. The form is based on the Microsoft Access platform. It is secure and accessed only by named clinicians on ward. The interface is user-friendly and mostly made by simple drop-down menus. The data collected is not extensive but include what we need for data processing and article publishing based on literature.

Figure 1: The form.

The data entered by the form is stored as Microsoft Access Database Table. The form is divided into "Patient info" at the left and "Complications" at the right.

Patient Data

This category includes all demographic, co-morbidities and procedure-related information. Data is categorized in menus and sub-menus that facilitate data processing and comparison afterwards.

• ID: Identification number that must correlate to a pre-defined format (individualized).

• BACKROUND: Multiple-choices of co-morbidities in a dropdown menu.

• DATE OF OPERATION: Click on the calendar or enter the date manually.

• ORGAN, PROCEDURE: Each procedure is organized by the organ involved and sub-categorized according to the procedure itself.

• METHOD, ETIOLOGY, URGENCY OF SURGERY: For retrieval and comparison purposes.

• COMMENTS: A box that serves occasional users if something is not listed.

Complications

The "Complications" category is made by drop-down menus only. The complications are sub-categorized according to well-known classifications employed in surgical texts and based on Clavien- Dindo [1] grade. A validation box has been added for designing a debilitating complication. A link to the Clavien-Dindo table is present for quick reference.

Buttons

At the bottom of the form we have two simple visual clickable buttons. The left one is for saving the data and the right for adding a new entry.

The Database

The database part of the file is the heart of the program. It includes the "Main table" and other tables. Just the Main Table is accessible for the occasional user. Other ones are hidden and accessible only by the database administrator.

Main Table

This table comprise all the data entered by the form previously presented Figure 2. The data is ranged in lines, each patient having his distinct ID (given sequentially by the program). Each detail of "Patient Info" and "Complications" categories is shown in a different column. The table is fully searchable and a subpopulation query can be easily retrieved by using filters appearing at the top of each column.

Figure 2: The Main table.

This allow us to retrieves data that we want to look at in seconds (eg. comparison of complications between open and laparoscopic colonic surgery) and can be linked to SQL server for multi-center cooperation. Also, the database can be exported to Microsoft Excel or imported by IBM SPSS Statistics for further analysis.

Other Tables

These tables represent the menus and sub-menus of each dropdown menu of the form. They allow the administrator to add a new entry for co-morbidity, procedure-related or complicationrelated data that was not previously included in the file. The "Comments" box in the form are intended to wake attention to the administrator to add a new entry in drop-down menus.

Conclusion

We presented here a friendly simple database interface for surgical complication recording for general surgery in-patients. Easily retrieved data can serve as a department or hospital-based registry. Further applications can be developed in all aspect of surgical practice: trauma scores and prognosis, margin of normal tissue in oncological surgery, change in audition acuity after ENT surgery, and a potential application in the daily evaluation of critically ill patients.

References

1. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg, pp: 205-213.