GynOnc Peri-operative Morbidity

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GynOnc Peri-operative Morbidity by Mind Map: GynOnc Peri-operative Morbidity

1. Haemorrhage

1.1. yes

1.1.1. transfusion required

1.1.2. requiring packing

1.1.3. requiring interventional radiology

1.1.4. return to theatre

1.2. no

2. Intra-operative

2.1. Anaesthetic

2.1.1. cardiac arrest requiring cardioversion

2.1.1.1. yes

2.1.1.2. no

2.1.2. Cardiac arrhythmias

2.1.2.1. no

2.1.2.2. yes

2.1.3. Aspiration

2.1.3.1. I - Any deviation from the normal postoperative course without the need for pharmacological treatment or surgical, endoscopic and radiological interventions. Allowed therapeutic regimens are: drugs as antiemetics, antipyretics, analgetics, diuretics and electrolytes and physiotherapy. This grade also includes wound infections opened at the bedside.

2.1.3.2. II - Requiring pharmacological treatment with drugs other than such allowed for grade I complications. Blood transfusions and total parenteral nutrition are also included.

2.1.3.3. III - Requiring surgical, endoscopic or radiological intervention under sedation, regional or general anaesthesia.

2.1.3.4. IV - Life-threatening complication (including CNS complications)‡ requiring IC/ICU-management.

2.1.3.5. V - Death

2.1.4. Allergic reaction

2.1.4.1. I - Any deviation from the normal postoperative course without the need for pharmacological treatment or surgical, endoscopic and radiological interventions. Allowed therapeutic regimens are: drugs as antiemetics, antipyretics, analgetics, diuretics and electrolytes and physiotherapy. This grade also includes wound infections opened at the bedside.

2.1.4.2. II - Requiring pharmacological treatment with drugs other than such allowed for grade I complications. Blood transfusions and total parenteral nutrition are also included.

2.1.4.3. III - Requiring surgical, endoscopic or radiological intervention under sedation, regional or general anaesthesia.

2.1.4.4. IV - Life-threatening complication (including CNS complications)‡ requiring IC/ICU-management.

2.1.4.5. V - Death

2.1.5. Dural tap

2.1.5.1. yes

2.1.5.2. no

2.2. Vascular injury with blood loss >500ml

2.2.1. yes

2.2.2. no

2.3. Accidental GI tract injury (full thickness)

2.3.1. stomach

2.3.1.1. yes

2.3.1.2. no

2.3.2. small bowel

2.3.2.1. yes

2.3.2.2. no

2.3.3. large bowel

2.3.3.1. yes

2.3.3.2. no

2.4. Accidental bladder injury (full thickness)

2.4.1. yes

2.4.2. no

2.5. Ureteric injury (full thickness)

2.5.1. yes

2.5.2. no

2.6. Equipment related

2.6.1. uterine perforation

2.6.1.1. yes

2.6.1.2. no

2.6.2. lost swabs or instruments

2.6.2.1. yes

2.6.2.1.1. I - Any deviation from the normal postoperative course without the need for pharmacological treatment or surgical, endoscopic and radiological interventions. Allowed therapeutic regimens are: drugs as antiemetics, antipyretics, analgetics, diuretics and electrolytes and physiotherapy. This grade also includes wound infections opened at the bedside.

2.6.2.1.2. II - Requiring pharmacological treatment with drugs other than such allowed for grade I complications. Blood transfusions and total parenteral nutrition are also included.

2.6.2.1.3. III - Requiring surgical, endoscopic or radiological intervention under sedation, regional or general anaesthesia.

2.6.2.1.4. IV - Life-threatening complication (including CNS complications)‡ requiring IC/ICU-management.

2.6.2.1.5. V - Death

2.6.2.2. no

3. Post-operative

3.1. Thromboembolic Disease

3.1.1. Confirmed DVT

3.1.1.1. I - Any deviation from the normal postoperative course without the need for pharmacological treatment or surgical, endoscopic and radiological interventions. Allowed therapeutic regimens are: drugs as antiemetics, antipyretics, analgetics, diuretics and electrolytes and physiotherapy. This grade also includes wound infections opened at the bedside.

3.1.1.2. II - Requiring pharmacological treatment with drugs other than such allowed for grade I complications. Blood transfusions and total parenteral nutrition are also included.

3.1.1.3. III - Requiring surgical, endoscopic or radiological intervention under sedation, regional or general anaesthesia.

3.1.1.4. IV - Life-threatening complication (including CNS complications)‡ requiring IC/ICU-management.

3.1.1.5. V - Death

3.1.2. Confirmed PE - high risk on imaging and/or treated

3.1.2.1. I - Any deviation from the normal postoperative course without the need for pharmacological treatment or surgical, endoscopic and radiological interventions. Allowed therapeutic regimens are: drugs as antiemetics, antipyretics, analgetics, diuretics and electrolytes and physiotherapy. This grade also includes wound infections opened at the bedside.

3.1.2.2. II - Requiring pharmacological treatment with drugs other than such allowed for grade I complications. Blood transfusions and total parenteral nutrition are also included.

3.1.2.3. III - Requiring surgical, endoscopic or radiological intervention under sedation, regional or general anaesthesia.

3.1.2.4. IV - Life-threatening complication (including CNS complications)‡ requiring IC/ICU-management.

3.1.2.5. V - Death

3.2. Ileus >5 days managed with TPN

3.2.1. 0 - No

3.2.2. I - Any deviation from the normal postoperative course without the need for pharmacological treatment or surgical, endoscopic and radiological interventions. Allowed therapeutic regimens are: drugs as antiemetics, antipyretics, analgetics, diuretics and electrolytes and physiotherapy. This grade also includes wound infections opened at the bedside.

3.2.3. II - Requiring pharmacological treatment with drugs other than such allowed for grade I complications. Blood transfusions and total parenteral nutrition are also included.

3.2.4. III - Requiring surgical, endoscopic or radiological intervention under sedation, regional or general anaesthesia.

3.2.5. IV - Life-threatening complication (including CNS complications)‡ requiring IC/ICU-management.

3.2.6. V - Death

3.3. Bowel obstruction

3.3.1. small bowel

3.3.1.1. 0 - No

3.3.1.2. I - Any deviation from the normal postoperative course without the need for pharmacological treatment or surgical, endoscopic and radiological interventions. Allowed therapeutic regimens are: drugs as antiemetics, antipyretics, analgetics, diuretics and electrolytes and physiotherapy. This grade also includes wound infections opened at the bedside.

3.3.1.3. II - Requiring pharmacological treatment with drugs other than such allowed for grade I complications. Blood transfusions and total parenteral nutrition are also included.

3.3.1.4. III - Requiring surgical, endoscopic or radiological intervention under sedation, regional or general anaesthesia.

3.3.1.5. IV - Life-threatening complication (including CNS complications)‡ requiring IC/ICU-management.

3.3.1.6. V - Death

3.3.2. large bowel

3.3.2.1. 0 - No

3.3.2.2. I - Any deviation from the normal postoperative course without the need for pharmacological treatment or surgical, endoscopic and radiological interventions. Allowed therapeutic regimens are: drugs as antiemetics, antipyretics, analgetics, diuretics and electrolytes and physiotherapy. This grade also includes wound infections opened at the bedside.

3.3.2.3. II - Requiring pharmacological treatment with drugs other than such allowed for grade I complications. Blood transfusions and total parenteral nutrition are also included.

3.3.2.4. III - Requiring surgical, endoscopic or radiological intervention under sedation, regional or general anaesthesia.

3.3.2.5. IV - Life-threatening complication (including CNS complications)‡ requiring IC/ICU-management.

3.3.2.6. V - Death

3.4. Bowel perforation or anastomotic leak

3.4.1. small bowel

3.4.1.1. 0 - No

3.4.1.2. I - Any deviation from the normal postoperative course without the need for pharmacological treatment or surgical, endoscopic and radiological interventions. Allowed therapeutic regimens are: drugs as antiemetics, antipyretics, analgetics, diuretics and electrolytes and physiotherapy. This grade also includes wound infections opened at the bedside.

3.4.1.3. II - Requiring pharmacological treatment with drugs other than such allowed for grade I complications. Blood transfusions and total parenteral nutrition are also included.

3.4.1.4. III - Requiring surgical, endoscopic or radiological intervention under sedation, regional or general anaesthesia.

3.4.1.5. IV - Life-threatening complication (including CNS complications)‡ requiring IC/ICU-management.

3.4.1.6. V - Death

3.4.2. large bowel

3.4.2.1. 0 - No

3.4.2.2. I - Any deviation from the normal postoperative course without the need for pharmacological treatment or surgical, endoscopic and radiological interventions. Allowed therapeutic regimens are: drugs as antiemetics, antipyretics, analgetics, diuretics and electrolytes and physiotherapy. This grade also includes wound infections opened at the bedside.

3.4.2.3. II - Requiring pharmacological treatment with drugs other than such allowed for grade I complications. Blood transfusions and total parenteral nutrition are also included.

3.4.2.4. III - Requiring surgical, endoscopic or radiological intervention under sedation, regional or general anaesthesia.

3.4.2.5. IV - Life-threatening complication (including CNS complications)‡ requiring IC/ICU-management.

3.4.2.6. V - Death

3.5. Ureter perforation/anastomotic leak

3.5.1. 0 - No

3.5.2. I - Any deviation from the normal postoperative course without the need for pharmacological treatment or surgical, endoscopic and radiological interventions. Allowed therapeutic regimens are: drugs as antiemetics, antipyretics, analgetics, diuretics and electrolytes and physiotherapy. This grade also includes wound infections opened at the bedside.

3.5.3. II - Requiring pharmacological treatment with drugs other than such allowed for grade I complications. Blood transfusions and total parenteral nutrition are also included.

3.5.4. III - Requiring surgical, endoscopic or radiological intervention under sedation, regional or general anaesthesia.

3.5.5. IV - Life-threatening complication (including CNS complications)‡ requiring IC/ICU-management.

3.5.6. V - Death

3.6. Ureteric obstruction

3.6.1. 0 - No

3.6.2. I - Any deviation from the normal postoperative course without the need for pharmacological treatment or surgical, endoscopic and radiological interventions. Allowed therapeutic regimens are: drugs as antiemetics, antipyretics, analgetics, diuretics and electrolytes and physiotherapy. This grade also includes wound infections opened at the bedside.

3.6.3. II - Requiring pharmacological treatment with drugs other than such allowed for grade I complications. Blood transfusions and total parenteral nutrition are also included.

3.6.4. III - Requiring surgical, endoscopic or radiological intervention under sedation, regional or general anaesthesia.

3.6.5. IV - Life-threatening complication (including CNS complications)‡ requiring IC/ICU-management.

3.6.6. V - Death

3.7. Fistula

3.7.1. I - Any deviation from the normal postoperative course without the need for pharmacological treatment or surgical, endoscopic and radiological interventions. Allowed therapeutic regimens are: drugs as antiemetics, antipyretics, analgetics, diuretics and electrolytes and physiotherapy. This grade also includes wound infections opened at the bedside.

3.7.2. II - Requiring pharmacological treatment with drugs other than such allowed for grade I complications. Blood transfusions and total parenteral nutrition are also included.

3.7.3. III - Requiring surgical, endoscopic or radiological intervention under sedation, regional or general anaesthesia.

3.7.4. IV - Life-threatening complication (including CNS complications)‡ requiring IC/ICU-management.

3.7.5. V - Death

3.7.6. Yes

3.7.6.1. Vesicovaginal

3.7.6.2. Enterocutaneous

3.7.6.3. Enterovaginal

3.7.6.4. Ureterovaginal

3.7.6.5. Other

3.7.6.5.1. narrative text

3.7.7. No

3.8. Incisional hernia

3.8.1. Yes

3.8.1.1. I - Any deviation from the normal postoperative course without the need for pharmacological treatment or surgical, endoscopic and radiological interventions. Allowed therapeutic regimens are: drugs as antiemetics, antipyretics, analgetics, diuretics and electrolytes and physiotherapy. This grade also includes wound infections opened at the bedside.

3.8.1.2. II - Requiring pharmacological treatment with drugs other than such allowed for grade I complications. Blood transfusions and total parenteral nutrition are also included.

3.8.1.3. III - Requiring surgical, endoscopic or radiological intervention under sedation, regional or general anaesthesia.

3.8.1.4. IV - Life-threatening complication (including CNS complications)‡ requiring IC/ICU-management.

3.8.1.5. V - Death

3.8.2. No

3.9. Urinary retention

3.9.1. Yes

3.9.1.1. I - Any deviation from the normal postoperative course without the need for pharmacological treatment or surgical, endoscopic and radiological interventions. Allowed therapeutic regimens are: drugs as antiemetics, antipyretics, analgetics, diuretics and electrolytes and physiotherapy. This grade also includes wound infections opened at the bedside.

3.9.1.2. II - Requiring pharmacological treatment with drugs other than such allowed for grade I complications. Blood transfusions and total parenteral nutrition are also included.

3.9.1.3. III - Requiring surgical, endoscopic or radiological intervention under sedation, regional or general anaesthesia.

3.9.1.4. IV - Life-threatening complication (including CNS complications)‡ requiring IC/ICU-management.

3.9.1.5. V - Death

3.9.2. No

3.10. Infection

3.10.1. Yes

3.10.1.1. Wound infection/cellulitis

3.10.1.1.1. I - Any deviation from the normal postoperative course without the need for pharmacological treatment or surgical, endoscopic and radiological interventions. Allowed therapeutic regimens are: drugs as antiemetics, antipyretics, analgetics, diuretics and electrolytes and physiotherapy. This grade also includes wound infections opened at the bedside.

3.10.1.1.2. II - Requiring pharmacological treatment with drugs other than such allowed for grade I complications. Blood transfusions and total parenteral nutrition are also included.

3.10.1.1.3. III - Requiring surgical, endoscopic or radiological intervention under sedation, regional or general anaesthesia.

3.10.1.1.4. IV - Life-threatening complication (including CNS complications)‡ requiring IC/ICU-management.

3.10.1.1.5. V - Death

3.10.1.2. UTI

3.10.1.2.1. I - Any deviation from the normal postoperative course without the need for pharmacological treatment or surgical, endoscopic and radiological interventions. Allowed therapeutic regimens are: drugs as antiemetics, antipyretics, analgetics, diuretics and electrolytes and physiotherapy. This grade also includes wound infections opened at the bedside.

3.10.1.2.2. II - Requiring pharmacological treatment with drugs other than such allowed for grade I complications. Blood transfusions and total parenteral nutrition are also included.

3.10.1.2.3. III - Requiring surgical, endoscopic or radiological intervention under sedation, regional or general anaesthesia.

3.10.1.2.4. IV - Life-threatening complication (including CNS complications)‡ requiring IC/ICU-management.

3.10.1.2.5. V - Death

3.10.1.3. LRTI

3.10.1.3.1. I - Any deviation from the normal postoperative course without the need for pharmacological treatment or surgical, endoscopic and radiological interventions. Allowed therapeutic regimens are: drugs as antiemetics, antipyretics, analgetics, diuretics and electrolytes and physiotherapy. This grade also includes wound infections opened at the bedside.

3.10.1.3.2. II - Requiring pharmacological treatment with drugs other than such allowed for grade I complications. Blood transfusions and total parenteral nutrition are also included.

3.10.1.3.3. III - Requiring surgical, endoscopic or radiological intervention under sedation, regional or general anaesthesia.

3.10.1.3.4. IV - Life-threatening complication (including CNS complications)‡ requiring IC/ICU-management.

3.10.1.3.5. V - Death

3.10.1.4. Collection

3.10.1.4.1. I - Any deviation from the normal postoperative course without the need for pharmacological treatment or surgical, endoscopic and radiological interventions. Allowed therapeutic regimens are: drugs as antiemetics, antipyretics, analgetics, diuretics and electrolytes and physiotherapy. This grade also includes wound infections opened at the bedside.

3.10.1.4.2. II - Requiring pharmacological treatment with drugs other than such allowed for grade I complications. Blood transfusions and total parenteral nutrition are also included.

3.10.1.4.3. III - Requiring surgical, endoscopic or radiological intervention under sedation, regional or general anaesthesia.

3.10.1.4.4. IV - Life-threatening complication (including CNS complications)‡ requiring IC/ICU-management.

3.10.1.4.5. V - Death

3.10.1.5. Sepsis focus unknown

3.10.1.5.1. I - Any deviation from the normal postoperative course without the need for pharmacological treatment or surgical, endoscopic and radiological interventions. Allowed therapeutic regimens are: drugs as antiemetics, antipyretics, analgetics, diuretics and electrolytes and physiotherapy. This grade also includes wound infections opened at the bedside.

3.10.1.5.2. II - Requiring pharmacological treatment with drugs other than such allowed for grade I complications. Blood transfusions and total parenteral nutrition are also included.

3.10.1.5.3. III - Requiring surgical, endoscopic or radiological intervention under sedation, regional or general anaesthesia.

3.10.1.5.4. IV - Life-threatening complication (including CNS complications)‡ requiring IC/ICU-management.

3.10.1.5.5. V - Death

3.10.2. No

3.11. MRSA bacteraemia

3.11.1. Yes

3.11.1.1. I - Any deviation from the normal postoperative course without the need for pharmacological treatment or surgical, endoscopic and radiological interventions. Allowed therapeutic regimens are: drugs as antiemetics, antipyretics, analgetics, diuretics and electrolytes and physiotherapy. This grade also includes wound infections opened at the bedside.

3.11.1.2. II - Requiring pharmacological treatment with drugs other than such allowed for grade I complications. Blood transfusions and total parenteral nutrition are also included.

3.11.1.3. III - Requiring surgical, endoscopic or radiological intervention under sedation, regional or general anaesthesia.

3.11.1.4. IV - Life-threatening complication (including CNS complications)‡ requiring IC/ICU-management.

3.11.1.5. V - Death

3.11.2. No

3.12. Clostridium Difficile

3.12.1. Yes

3.12.1.1. I - Any deviation from the normal postoperative course without the need for pharmacological treatment or surgical, endoscopic and radiological interventions. Allowed therapeutic regimens are: drugs as antiemetics, antipyretics, analgetics, diuretics and electrolytes and physiotherapy. This grade also includes wound infections opened at the bedside.

3.12.1.2. II - Requiring pharmacological treatment with drugs other than such allowed for grade I complications. Blood transfusions and total parenteral nutrition are also included.

3.12.1.3. III - Requiring surgical, endoscopic or radiological intervention under sedation, regional or general anaesthesia.

3.12.1.4. IV - Life-threatening complication (including CNS complications)‡ requiring IC/ICU-management.

3.12.1.5. V - Death

3.12.2. No

3.13. Wound breakdown

3.13.1. Yes

3.13.1.1. Superficial

3.13.1.1.1. I - Any deviation from the normal postoperative course without the need for pharmacological treatment or surgical, endoscopic and radiological interventions. Allowed therapeutic regimens are: drugs as antiemetics, antipyretics, analgetics, diuretics and electrolytes and physiotherapy. This grade also includes wound infections opened at the bedside.

3.13.1.1.2. II - Requiring pharmacological treatment with drugs other than such allowed for grade I complications. Blood transfusions and total parenteral nutrition are also included.

3.13.1.1.3. III - Requiring surgical, endoscopic or radiological intervention under sedation, regional or general anaesthesia.

3.13.1.1.4. IV - Life-threatening complication (including CNS complications)‡ requiring IC/ICU-management.

3.13.1.1.5. V - Death

3.13.1.2. Deep

3.13.1.2.1. I - Any deviation from the normal postoperative course without the need for pharmacological treatment or surgical, endoscopic and radiological interventions. Allowed therapeutic regimens are: drugs as antiemetics, antipyretics, analgetics, diuretics and electrolytes and physiotherapy. This grade also includes wound infections opened at the bedside.

3.13.1.2.2. II - Requiring pharmacological treatment with drugs other than such allowed for grade I complications. Blood transfusions and total parenteral nutrition are also included.

3.13.1.2.3. III - Requiring surgical, endoscopic or radiological intervention under sedation, regional or general anaesthesia.

3.13.1.2.4. IV - Life-threatening complication (including CNS complications)‡ requiring IC/ICU-management.

3.13.1.2.5. V - Death

3.13.1.3. Burst abdomen

3.13.1.3.1. I - Any deviation from the normal postoperative course without the need for pharmacological treatment or surgical, endoscopic and radiological interventions. Allowed therapeutic regimens are: drugs as antiemetics, antipyretics, analgetics, diuretics and electrolytes and physiotherapy. This grade also includes wound infections opened at the bedside.

3.13.1.3.2. II - Requiring pharmacological treatment with drugs other than such allowed for grade I complications. Blood transfusions and total parenteral nutrition are also included.

3.13.1.3.3. III - Requiring surgical, endoscopic or radiological intervention under sedation, regional or general anaesthesia.

3.13.1.3.4. IV - Life-threatening complication (including CNS complications)‡ requiring IC/ICU-management.

3.13.1.3.5. V - Death

3.13.2. No

3.14. Lymphoedema

3.14.1. Yes

3.14.1.1. 1 - Mild swelling +/- faint discoloration

3.14.1.2. 2 - Marked swelling limiting activities of daily living +/- marked discoloration

3.14.1.3. 3 - Severe swelling limiting self-care

3.14.2. No

3.15. Lymphocyst

3.15.1. Yes

3.15.1.1. 1 - asymptomatic, clinical or diagnostic evaluation only, intervention not indicated

3.15.1.2. 2 - Symptomatic, outpatient or bedside management

3.15.1.3. 3 - Severe symptoms, radilogical/endoscopic or elective operative intervention indicated

3.15.2. No

3.16. Psychiatric complications

3.16.1. Yes

3.16.1.1. narrative text

3.16.2. No

3.17. Other

3.17.1. 1

3.17.1.1. narrative text

3.17.2. 2

3.17.2.1. narrative text

3.17.3. 3

3.17.3.1. narrative text

4. Scheduled with each admission for major procedure

5. Based on UKGOSOC data set with Clavien-Dindo classification

6. Name

7. DoB

8. OP codes

8.1. select from list

9. date of surgery

10. length of hospital stay

11. BMI

12. ASA

13. Procedure start (QCPR)

14. Procedure finish (QCPR)

15. Critical care admission

15.1. yes

15.1.1. length of CrCU admission in days

15.2. no

16. senior operating surgeon

17. responsible consultant

18. Incision

18.1. transverse

18.2. midline

18.3. laparoscopic

18.4. vulval

18.5. combined abdominal/perineal

19. ID