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Operative priority

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  • 1. National Minimum Data Set for Thoracic Surgery and Lung Cancer Surgery Revised by Tom Treasure 9th April 04 Based on provisionally agreed set following Thoracic Surgical Forum presentation 2003 Pilot run at Guy’s in a Dendrite environment. Presented to SCTS 2004 with a mandate to continue the project. Please e-mail questions to Richard Page, Thoracic Surgery, Liverpool E-mail Address(es): richard.page@ctc.nhs.uk The Ground Rules and Guiding Principles The data can be collected • within a Dendrite environment • or on Tomcat • or by any suitable local arrangement • or onto an Excel spread sheet (as supplied herewith) • or configured as an Access database locally. A hospital IT system should enable users to capture case numbers and dates of birth, admission, procedure and discharge without double entry. There will be great advantages in using a user-friendly front end such as Dendrite because the straight listing in the spread sheet is potentially confusing. However any practiced data handler will find the spread sheet approach easy to deal with once the fields are understood. The data will have to be returned in a common format. The “unit of entry” is an operative episode but this may include more than one procedure. Thus if the patient has any combination of • bronchoscopy/mediastinoscopy/lung resection • VATS/thoracotomy the individual procedures are recorded and can be retrieved but are within the operative episode. There are two levels of detail • What we will call “core data” is collected on all cases. • More detailed information is collected on lung cancer cases. In due course more detail may be collected on any subsets of interest and these may be chosen locally Entries will be “1” for the item if applicable. There is no need for “0” or “N”. If there is date required enter DDMMYYYY. Core Data (collected on all cases) line 1-76 and 124-132 1. Centre identification. Enter as text or as pre-defined code. This should be an automatic part of a local system. 2. NHS number. Enter as 10 digit number with no spaces or import from hospital PAS. This will enable tracking to death certification. Clearly capture from PAS as can be done with Dendrite or tomcat is the best way. 1
  • 2. 3. Hospital number. Until we all use NHS numbers this will be needed to track back to you cases for data verification etc. Enter in local format or import from Hospital PAS. Clearly this is the best way. 4. Post code This has two purposes. One is that you know where your cases come from. The other is that any secondary use for research will allow us to link to deprivation indices. 5. Date of Birth. Enter as DDMMYYYY (subject to advice) or import from Hospital PAS. Used to calculate age in years at surgery by subtracting from Date of Operation. 6. Sex. M or F 7. Date of Operation Date on which primary procedure takes place – enter as DDMMYYYY. This register is built around a surgical procedure. 8. Date of surgical referral - DDMMYYYY 9. Date of first surgical assessment 10. This field no longer required (Consultant’s GMC number) 11. This field no longer required (Operator GMC number) Operative priority Select a single choice from 12. Elective – standard booked admission for surgery. 13. Urgent – decision to operate on next available list 14. Emergency – operation arranged outside scheduled list Surgical strategy Reasons for the operation taking place There may be more than one 15. Diagnostic - to diagnose the condition 16. Staging or assessment – to stage a neoplasm or to assess the progress of the condition 17. Therapeutic – to cure, alleviate or palliate More than one is allowed, for example: • Mediastinoscopy – maybe diagnostic and staging • VATS pleural biopsy and pleural biopsy – diagnostic and therapeutic • Thoracotomy, frozen section and proceed - diagnostic and therapeutic Pathological category It is the pathological category (based on what used to be called the “surgical sieve”) of the aetiology of the condition for which surgery is being performed. They include specific commonly occurring thoracic diagnoses. This is visited twice. At the time of the surgical procedure and revisited at discharge when it is revised. Multiple answers are allowed. The box on the spread sheet gives a brief explanation of what is required. Enter “1” if applicable 18. Congenital 19. Trauma/accident 20. Primary cancer lung (known or probable) 21. Oesophageal cancer 22. Mesothelioma 23. Other primary thoracic malignancy 24. Malignant disease other (secondary, recurrent or metastatic) 25. Carcinoid 26. Benign neoplasms 27. Empyema (include all aetiologies of pleural sepsis) 28. Parenchymal lung disease (as the pathology of interest – not comorbidity) 2
  • 3. 29. Vascular lesion 30. Pneumothorax 31. Pleural effusion 32. Other (write in) Multiple entries are allowed. You may have to deal with an empyema where the initiating problem was trauma (stabbing for example). Both are worth retrieving to count trauma and to count empyema so enter both. The data analyst can recognise that the operative episode was single. Procedure type Multiple entries are appropriate if performed in the same session. Select the options that best describe the operation as a whole – if there was more than one procedure, enter each. The data analyst can see that they are part of a single operative episode. The purpose of the data collected here is to indicate service volume and workload. 33. Endoscopy (bronchoscopy/oesophagoscopy +/- biopsy) 34. Endoscopy (bronchoscopy/oesophagoscopy + any other procedure) 35. Drain insertion 36. Other minor procedure (of the scale of node biopsies) 37. Mediastinoscopy and/or mediastinotomy 38. Other intermediate procedure (of the scale of rib resection) 39. VATS 40. Thoracotomy 41. Median sternotomy 42. Other major incision Primary organ/System targeted Select the main target organ(s) of the operation. This is an anatomical list More than one may be entered but coincidental surgery, such as chest wall if that is purely the route of access, will not be helpful in data analysis. 43. Aorta and/or great vessels 44. Chest wall 45. Diaphragm 46. Lung 47. Mediastinum 48. Oesophagus 49. Pericardium 50. Pleura 51. Thymus 52. Thyroid 53. Trachea and/or main bronchi 54. Other Named operations Select the procedure(s) performed at this operation. Thus pleural biopsy and pleurodesis can both be entered. This is not a comprehensive list but is derived from the registry list of operations performed more than about fifty or so times per annum and/or which are well defined set piece procedures. 55. Lobectomy (any indication) 56. Lobectomy (complex) with chest wall etc or bilobectomy 57. Pneumonectomy (any indication) 58. Sub lobar lung resection wedge or segmentectomy 59. Mediastinoscopy/mediastinotomy 3
  • 4. 60. Pneumothorax surgery (any technique) 61. Lung volume reduction and/or bullectomy 62. Pleurodesis for effusion 63. Pleural biopsy (any technique) 64. Decortication 65. Oesophageal resection (any) 66. Hiatus hernia surgery (any) 67. Pectus surgery 68. Sympathectomy 69. Thymectomy for myasthenia 70. Thymectomy for thymoma 71. Thyroid surgery 72. Bronchoscopy 73. Oesophagoscopy 74. Chest drain insertion 75. Other (enter) Lung cancer data set (76-123) 76. Is this operation for Lung cancer (Core) If the answer is ‘No’ proceed to Discharge section. If the answer is ‘Yes’ answer specialised questions for lung cancer surgery. Omit where data is not available. Do not estimate. If data are too incomplete to analyse it’s better that we know that. Lung Cancer Surgery Data Set – Pre-Operative Diagnostic Staging of Primary Lung Cancer 77. CT 78. MRI 79. PET 80. Tissue diagnosis preop (includes bronchoscopic, FNA, CT needle and cytology as long as it is regarded as proof of cancer) Lung Cancer Surgery Data Set – Histological Diagnosis Update after surgery if it changes. This is not an audit of the preoperative diagnostic accuracy. The definitive histology is what we need. 81. Small cell 82. NSCLC 83. Squamous 84. Adeno 85. Undifferentiated 86. Broncheoalveolar 87. Other or further information (write in) Preoperative staging 88. T stage 89. N stage 90. M stage Neoadjuvant therapy 91. Chemotherapy preop 92. Radiotherapy preop Lung Cancer Surgery Data Set – Pulmonary Risk Factors 93. Measured FEV1 4
  • 5. 94. %predicted FEV1 (an algorithm can be included to calculated this1) 95. Measured FVC 96. % Predicted FVC 97. Diffusion capacity by DLCO 98. Never smoked 99. Pack years Lung Cancer Surgery Data Set – Non Pulmonary Risk Factors 100.Height The patient’s height in centimetres – enter as whole number. 101.Weight The patient’s weight in kilograms – enter to one decimal place. Dendrite and tomcat automate these calculations to produce BMI or body surface area (BSA). This list is too long. Factors which are not useful in risk stratification will be eliminated in future editions of the data base 102.Urea (mmol/L) 103.Creatinine (µmol/L) 104.Hb (g/dL) 105.Insulin dependent diabetes 106.Ischaemic Heart Disease 107.Cardiac failure 108.Previous Stroke 109.Steroid therapy 110.Anticoagulation with warfarin or equivalent therapy 111.Performance (ECOG) 112.ASA Grade American Society of Anaesthetists grade Lung Cancer Surgery Data Set – Surgical Resection performed Lobes removed. This covers pneumonectomy and any bilobectomy 113.Frozen section taken for diagnosis 114.Frozen section for staging 115.Left upper lobe 116.Left lower lobe 117.Right upper lobe 118.Middle lobe 119.Right lower lobe 120.Sublobar resection (whether wedge or segment) Lung Cancer Surgery Data Set pTNM staging 121.T stage 122.N stage 123.M stage Discharge 124.No complications 125.Reintubation or ITU Admission DDMMYYYY 126.Date of Discharge from ITU DDMMYYYY 127.IPPV 128.Air leak >7 days 129.Infection requiring longer hospital stay 130.Further surgery within the same admission 131.Date of Discharge/Death (Core) 132.Death y/n (provide cause on death certificate) 5
  • 6. Reference List 1. Quanjer PH, Tammeling GJ, Cotes JE, Pedersen OF, Peslin R, Yernault JC. Lung volumes and forced ventilatory flows. Report Working Party Standardization of Lung Function Tests, European Community for Steel and Coal. Official Statement of the European Respiratory Society. Eur.Respir.J.Suppl 1993;16:5-40. 6