Transcript Plastic Surgery SCGH

Plastic Surgery SCGH
Unit Audit
20th of September – 5th of December
2004
Marosh Vrtik
Lip Teh
David Oliver
OVERVIEW
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Outpatient Clinics
Plastics Dressings Clinic
Inpatient Information
Operative Data
Complications
Presentation
Discussion
Outpatient Clinic Case Load
Total
P. Briggs
Follow New
up
166
51
217
Year To
Date
924
C. Allen
94
33
127
516
T. Cooper
122
46
168
682
S. Hamilton 157
R. Page
J. Savundra 19
41
5
198
20
775
145
46
TOTAL
176
730
3088
558
Outpatient Clinic Case Load
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2002: 3167
3000
2500
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2003: 3195
2004: 3289
2000
New
Fup
1500
1000
500
0
2002 2003 2004
Plastics Dressings Clinic
Audit Period
New Cases
303
Follow up
1638
Total:
1941
Plastics Dressings Clinic
2002
2003
2004
New Cases 1001
1071
1332
Follow up
6732
6729
7478
Total:
7733
7800
8810
Admissions
Audit Period
ALOS
Allen C.
71
2.99
Briggs P.
118
2.17
Hanikeri M.
Cooper T.
Hamilton S.
Love R.
Savundra J.
TOTAL
2
100
43
5
76
331
3.5
1.99
3.88
3.00
1.87
2.02
Admissions
2002
Unit Total:
2003
2004
incomplete
1851
1841
1912
Unit ALOS: 3.32
2.63
2.79
Operations by Providers Audit
Period
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Allen C.
Briggs P.
Cooper T.
Hamilton S.
Hanikeri M.
Love R.
Savundra J.
TOTAL:
60
100
91
40
5
6
45
347
Operations
2002
Total
1693
2003
1722
2004
Incomplete
1829
Operations by Categories
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General Plastics
Hand Surgery
Breast Surgery
Craniofacial
Microsurgery
Head and Neck
Cosmetic Surgery
Burns
159
152
19
16
7
7
4
0
TOTAL:
363
FLAPS
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FREE :
TRAM
Radial forearm
Rectus myocutaneous
Thumb replant
3
1
2
1
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Pedicled:
Lat Dorsi
Gastrocnemius
Reverse Radial Forearm
TRAM
4
1
1
2
Operative Experience
Lip TEH
Assistance
1st Operator
Microsurgery
0
4
Hand Surgery
3
92
General Plastics
4
62
Breast Surgery
3
10
Head and Neck
1
1
Cosmetics
2
0
Craniofacial
5
9
Total:
187
Operative Experience
Marosh Vrtik
Assistance
1st Operator
Hand Surgery
15
General plastics 7
48
47
Breast Surgery
4
0
Head and neck
4
0
Craniofacial
1
2
Cosmetic
2
0
Micro
0
2
Total: 125
Operative Experience
David Oliver
Assistance
Hand Surgery
10
1st Operator
52
General plastics 8
35
Breast Surgery
7
4
Head and neck
1
0
Craniofacial
3
4
Cosmetic
1
0
Micro
0
3
Total: 128
Use of Elective Lists for Trauma
During Audit Period
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41 registrar lists (11 weeks)
3 cases per list -> 123 slots available
225 trauma cases
60 trauma cases on elective lists i.e.
“cancellations”
Time from Presentation to
SURGERY
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18 Patients
Range: 1.75 – 48 hours
Average: 13.8 hours
< 6 hours
7 patients
> 6 hours
2 patients
>12 hours
3 patients
>18 hours
2 patient
>24 hours
3 patients
48 hours
1 patient
Complications: Incomplete
excisions
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110 Patients with cutaneous lesions
7 (6%) incomplete excisions for skin lesions
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Clive Foley (SCC-insitu cheek) – Hamilton
Dawn Brennan (BCC nose) – Allen
Marion Rawlings (BCC ear) – Cooper
Ronald Fernihough (SCC parotid) - Allen
Richard Roberts (BCC scalp) – Cooper
Trevor Graham (melanoma chest) - Hamilton
Hector Mason (BCC ear) - Cooper
Complications: Level 3
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Eric Kay
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Mr. Allen
72 year old man
Adenoid cystic carcinoma Rt Maxilla
Maxillectomy and reconstruction with free rectus
flap and rib grafts 5.11.04
 Reexplored 7.11.04 ?venous congestion
 Opthalmoplegia, pulmonary oedema, left sided
pneumonia, staph sepsis
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Complications: Level 3
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Rebecca FERNANDEZ
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Mr. Allen
20 year old female
T4 N1 M0 SCC tongue
Glossectomy, bilateral neck dissection and
reconstruction with free rectus flap 22.10.04
 Reexplored 23.10.04 ?arterial occlussion
 Tongue flap debulked 3 weeks later
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Complications: Level 3
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Earl BOXALL
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Mr. Cooper
54 year old male
T3 N1 SCC floor of mouth
WLE, marginal mandibulectomy, bilateral neck
dissection and reconstruction with free radal
forearm flap 22.11.04
 Reexplored 23.11.04 venous occlussion
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1 vein thrombosed, 1 vein kinked
Incomplete excision – reexcision planned 20.12.04
Complications: Level 3
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Diane KIRBY
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Mr. Allen
55 year old woman
LT Lar Dorsi and Expander Breast Recon
24.9.04
Cellulitis and ?Ruptured expander 11.12.04
 Removal of expander 15.12.04
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Micro coag neg staph
Complications Level 3
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Laura GRIMES
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Mr. Allen
50 yr old female
Lt Lat dorsi and expander reconstruction Jan 04
 Admitted for cellulitis 5.11.04
 Unresponsive to IV antibiotics
 Washout and implant removal 10.11.04
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Micro no growth
Complications: Level 3
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Olive CARBONI
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69 year old female
Lt calf degloving laceration
Suture repair 2.10.04
 Flap necrosis and cellulitis
 Debridement and SSG 11.10.04
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Mr. Allen
Complications: Level 3
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Craig DIXON
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Mr. Cooper
28 year old man
Post traumatic scar contracture left third ray
Scar release, Z plasties 12.10.04
 Skin necrosis, exposed flexor tendons
 Cross finger flap 21.10.04
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Complications Level 3
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Timothy GROUNDS
Mr. Savundra/Love
- 40 yr old man
- Bilateral buttock pressure ulcers
- Debrided 29.10.04
- Direct closure Lt side 2.12.04
dehisced following seizure
- SSG 13.12.04
Complications Level 3
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Cheryl BUCHANEN
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Mr. Briggs
50yr old female
Bilateral wrist lacerations
 Repaired 10.11.04
 Infected with enterobacter cloacae
 Washout 15.11.04 – ruptured FCR
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Complications Level 3
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Anne HULL
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Mr. Savundra
52yr old female
Rt leg laceration from lawn mover
 Repaired 19.11.04
 Skin necrosis/cellulitis
 Debrided 26.11.04
 SSG 31.11.04
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Complications Level 3
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Richard ROBERTS
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Mr. Cooper
70 yr old male
BCC scalp 26.11.04
 Excision and SSG
 Hematoma, loss of SSG, incomplete excision
 Reexcision and SSG 3.12.04
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Complications Level 3
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Andrea SKAHILL
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Mr. Hamilton
41yr old female
Munchausens
 Chronic Left thigh ulcer
 Debridement and SSG harvest 21.10.04
 Complete SSG loss
 Debrided, SSG harvest and tension banding
2.12.04
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Complications Level 3
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Kevin THOMPSON
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Mr. Cooper
43 yr old male
Bilateral trigger finger releases
(RIF,RMF,RRF,LMF,LRF) 5.10.04
 RIF still triggering
 Explored LAOP 18.11.04
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Synovectomy, partial A2 pulley release