Surgery Audit 2013

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Surgery Audit 2013

  1. 1. DISTRIBUTION OF RED AREA PATIENTS TRAUMA SURGERY PTS ADMITTED TRANSFER OUT DISCHARGED 2013 525 33 02 2012 242 25 03 2011 200 10 1
  2. 2. Admissions 2013 Area No. admitted Transfer -out Red 525 33 Yello w 350 5 Gree n Nil Nil 2012 Area No. admitte d Transfe r-out Red `242 25 Yello w 381 5 Gree n Nil Nil 2011 Area No. admitte d Transfe r-out Red 126 35 Yello w 232 50 Gree n nil nil
  3. 3. Interventions ED Interventions( 2012) Procedure No Suturing 22188 ICDT insertion 265 Cricothyroidotom y 15 Venous cut-down 4 SPC 24 ED Interventions (2013) Procedure No Suturing 15162 ICDT insertion 146 Cricothyroidoto my 05 Venous cut- down 7 SPC 11 ED Interventions (2011) Procedure No Suturing 21451 ICDT insertion 214 Cricothyroidotom y 8 Venous cut-down 02 SPC 19
  4. 4. DEMOGRAPHIC PROFILE 120 210 275 375 180 130 60 20 70 140 210 270 140 100 40 10 50 120 190 240 110 80 45 7 0 50 100 150 200 250 300 350 400 less than 10 11-20 yrs 21-30 yrs 31-40 yrs 41-50 yrs 51-60 yrs 61-70 yrs more than 70 2013 2012 2011
  5. 5. MODE OF INJURY 585 140 255 60 60 709 320 210 20 50 624 122 189 27 40 0 100 200 300 400 500 600 700 800 RTI Fall from height Assault self inflicted Accidental 2013 2012 2011
  6. 6. MODE OF RTIs 18 3 252 40 3 50 45 14 160 21 2 333 32 4 82 27 10 212 15 1 260 36 2 75 30 11 150 0 50 100 150 200 250 300 350 2013 2012 2011
  7. 7. 2 Wheeler RTI 2013 2012 RIDER (n=212) PILLON (n=40) RIDER (n=270) PILLON (n=63) HELMET 190 25 167 29 WITHOUT HELMET 22 15 103 34
  8. 8. Abdominal Trauma
  9. 9. Abdominal Trauma Part involved 2013 2012 2011 Solid Organ(Liver &Spleen) Single Organ 277 247 210 Multiple Organs 21 33 24 Hollow Viscera 131 154 90 Genito- urinary 107 78 67 Pancreatico- duodenal 17 19 21
  10. 10. LIVER TRAUMA 0 5 10 15 20 25 30 35 40 45 50 GRADE 1 GRADE 2 GRADE 3 GRADE 4 GRADE 5 2013 2012 2011
  11. 11. Management of liver trauma 2013 2012 2011 mortality 9 19 20 MANAGEMENT 2013 2012 2011 OM 16 29 28 OM + EMB. 07 9 0 EMBOLIZATION 22 16 12 NOM 60 87 58 Laparotomy for other injuries 09 19 5
  12. 12. SPLENIC TRAUMA
  13. 13. SPLENIC TRAUMA 0 5 10 15 20 25 30 35 40 Grade 1 Grade 2 Grade 3 Grade 4 Grade 5 2013 2012 2011
  14. 14. Management 0 10 20 30 40 50 60 70 80 90 splenectomy embolization NOM splenoraphy 2013 2012 2011
  15. 15. HOLLOW VISCUS TRAUMA
  16. 16. HOLLOW VISCUS TRAUMA 0 10 20 30 40 50 60 70 80 90 100 2013 2012 2011
  17. 17. HOLLOW VISCUS PROCEDURES 2013 2012 2011 Esophagus Primary Repair 2 2 1 Cervical esophagostomy 2 3 1 Stomach Repair 6 7 4 Jejunum Repair 9 20 12 RA + FJ 20 25 16 Ileum Repair 6 12 4 RA 7 13 4 Ileostomy 17 9 8 Colon+rectum Repair 4 10 3 RA 5 9 3 End colostomy 18 10 12 Loop colostomy 14 8 6 Stoma closure (routine - OT ) Ileostomy reversal 9 12 4 Colostomy reversal 12 17 1
  18. 18. PANCREATICODUODENAL TRAUMA
  19. 19. PANCREATICODUODENAL TRAUMA 0 2 4 6 8 10 12 14 PANCREAS DUODENAL COMBINED 2013 2012 2011
  20. 20. Operative management OPERATIVE 2013 2012 2011 DISTAL PANCREATECTOMY 05 6 2 DISTAL PANCREATECTOMY WITH SPLENECTOMY 01 2 4 DEBRIDMENT + NECROSECTOMY 01 2 1 WHIPPLES’ PROCEDURE 02 0 1 TRIPLE TUBE DRAINAGE 02 5 UNCINATE PROCESS EXCISION +RESECTION OF D4 PART OF DUODENUM 0 1 3 2013 2012 2011 mortality 2 3 3
  21. 21. GENITOURINARY TRAUMA 32 37 35 3 0 5 10 15 20 25 30 35 40 45 50 KIDNEY BLADDER URETHRA URETER 2013 2012 2011
  22. 22. UROLOGY MANAGEMENT 2013 2012 2011 KIDNEY(42) Nephrectomy 03 5 5 NOM 24 31 25 Exp Lap for other indication 3 AE 2 0 Laproscopic renorrrhaphy 1 0 0 URETER DJ stenting 6 3 2 REPAIR&DJ 3 1 2 BLADDER (43) REPAIR 12 10 7 REPAIR&SPC 12 17 11 SPC 13 9 8 Laser lithotripsy 06 0 0
  23. 23. UROLOGY URETHRA (105) Urethroplasty(el ective) 105 54 13 SPC 40 32 20 URETHRA (105) Urethroplasty End to end 62 54 13 Perineal urethrostomy 03 02 01 Transpubic urethroplasty 03 02 Laser core through 14 0 0 Laser oiu 24 0 0
  24. 24. LAPROSCOPIC AND ENDOSCOPIC PROCEDURES PERCUTANEOUS ENDOSCOPIC GASTROSTOMY (PEG) AND FIBRE OPTIC BRONCHOSCOPY FOR LUNG COLLAPSE
  25. 25. LAPROSCOPIC AND ENDOSCOPIC PROCEDURES 2013 2012 2011 Diagnostic lap 26 8 Lap hernioplasty (elective) 4 2 Lap cholecystectomy 3 Lap diaphragmatic repair 3 2 Lap small bowel perf. repair 1 Lap foreign body removal(needle) 1 Upper GI endoscopy 1 3 PEG 2 2 Bronchoscopy 16
  26. 26. Thoracic Trauma
  27. 27. Thoracic Trauma 2013 2012 2011 Non- operative cases 345 358 With ICD 280 335 Without ICD 65 23 2013 2012 2011 VATS 1 6 2 Epidural 82 93 Descending thoracic aorta stenting 1 1 0 Diaphragma -tic repair abdominal approach 6 4 laproscopic 3 2
  28. 28. 2013 2012 2011 Operative 13 32 INDICATION FOR THORACOTOMY Pneumonecto my 01 3 2 Lobectomy 01 1 1 Bronchial repair 03 1 Massive Hemothorax 06 6 7 Resuscitative thoracotomy 5 7 Thoracoplasty 2 Decortication 5 7 F.B removal 3 1
  29. 29. Cardiac injuries STAB INJURY LEFT ANTERIOR CHEST CERVICAL COLLAR RIGHT NIPPLE STERNUM
  30. 30. Cardiac injuries Mechanisms of injury 2013 2012 2011 Blunt 0 3 2 Penetr ating Stab 3 2 0 GSW 2 2 1
  31. 31. VASCULAR INJURY
  32. 32. PERIPHERAL VASCULAR INJURY
  33. 33. PERIPHERAL VASCULAR INJURY TIME SINCE INJURY <6HRS >6 HRS 2013 2012 2011 2013 2012 2011 Upper limb Cases 52 39 24 16 26 20 Amput ation 07 2 1 05 4 4 Lower limb Cases 18 22 7 09 15 11 Amput ation 05 3 1 06 9 4
  34. 34. VESSEL INVOLVED VESSEL INVOLVED 2013 2012 2011 Brachial Artery 16 10 17 Radial Artery 22 12 11 Ulnar Artery 24 14 12 Radial+Ulnar Artery 6 3 4 Femoral artery 17 12 13 Popliteal Artery 10 6 5
  35. 35. CENTRAL VASCULAR INJURY 2013 2012 VESSEL INVOLVED NO MANAGEMENT NO MANAGEMENT Axillaty art./SUB CLAVIAN 04 Repair 2 cases 1 - expired(<6hrs),NOM -1( >24hrs),Amputation -1 03 REPAIR , STENTING , NOM DTA 01 Stenting IVC 03 Repair- 3cases (mortality -1) 02 REPAIR IIA 03 Ligated-2,repair -1(<6 hrs) 1 ligated HEPATIC ARTERY 03 Ligation (<6hrs),Repair- 2 c ases <6hrs Aorta 3 NOM-2, stenting
  36. 36. NECK INJURIES
  37. 37. NECK INJURIES 2013 2012 2011 TRACHEAL REPAIR + TRACHEOSTOMY 6 2 1 LIGATION OF INT JUG VEIN 01 2 F.B REMOVAL 02 2 0 NON THERAPEUTIC EXPLORATION 02 3 1 CERVICAL OESOPHAGOSTOMY 02 2 PRIMARY REPAIR OF HYPOPHARYNX 02 2 0 TRACHEAL REPAIR +CERVICAL ESOPHAGOSTOMY 03 1 4 HEMITHYROIDECTOMY 1 0 NOM 5 8 3
  38. 38. 2013 2012 CBD injury (blunt) (1.CBD mid part transection) (2.CBD contusion & perforation –mid part) 2 Infant feeding tube put inside for drainage T Tube drainage 1 ERCP stenting GB perforation 2013 2012 GB Penetrating 5 Cholecystectomy 2 Cholecystec tomy Blunt 4 Cholecystectomy 1 Cholecystec tomy GB gangrene 2 cholecystectomy Incidental stones - 1 cholecystec tomy EXTRAHEPATIC BILIARY SYSTEM
  39. 39. MAXILLO FACIAL INJURIES
  40. 40. MAXILLO FACIAL INJURIES 2013 2012 2011 Total 146 99 85 ORIF 54 66 74 Interdental wiring 9 22 11 Conservative 83 11 0
  41. 41. Operative Procedures Type of Ax 2013 2012 GA 1346 1402 Spinal 620 487 LA 98 29 REGIONAL 78 102 2013 2012 Total 2142 2020
  42. 42. PLASTIC & RECONSTRUCTIVE PROCEDURES 0 100 200 300 400 500 600 2013 2012 2011
  43. 43. Flaps
  44. 44. Early mortality( < 6Hrs ) 32 HS 88% Severe Head injury 6% Cardiac Injury 6% MEAN ISS – 48.61
  45. 45. INTERMEDIATE MORTALITY (6-24HRs) Mean ISS – 29.62 HS & sequelae 94% Severe Head injury 6%
  46. 46. LATE MORTALITY >24Hrs Sepsis & sequelae 31% VAP to ARDS 8% Brain injury 9% ARF 8% DIC 12% ARDS 7% sepsis 25% HS Sequelae 51%
  47. 47. OUR WORKFORCE Non acad JRs – Sanctione d Acad JRs SRs Pool Officer Trauma fellow Consultan ts 2011 10 3-4 18 0 1 5 2012 30 3-4 18 0 1 5+2 2013 30 3-4 18 1 1 5+2
  48. 48. McH IN TRAUMA M.S IN TRAUMA

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