Discussion of Complex Clinical Scenarios and Variable Review ACS NSQIP Clinical Support Team
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- Julia Booker
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1 Discussion of Complex Clinical Scenarios and Variable Review CS NSQIP Clinical Support Team
2 SCR Open Q& Calls The CS NSQIP Clinical Team is trialing Open format Q& calls for NSQIP SCRs Participation in calls is optional nswer general clinical questions Continue to send case specific questions to clinical support team 3 weeks a month on Tuesday and Thursday The ugust call schedule is available and will be posted to the CS NSQIP Main Page
3 SCR Open Q& Calls ugust 2014
4 ORGN/SPCE SSI Patient had a lap chole and returned to the ED due to abdominal pain. n abdominal CT was ordered. The results indicated a need for a CT aspiration. The CT impression read Possible interval development of ascites vs. abscess vs. fluid collection. The results from the fluid aspirated had no growth. Would you assign an Organ/Space SSI to this case You would not assign the post-operative occurrence of Organ/Space SSI to this case. You would assign the post-operative occurrence of Organ/Space SSI to this case.
5 ORGN/SPCE SSI Patient had a lap chole and returned to the ED due to abdominal pain. n abdominal CT was ordered. The results indicated a need for a CT aspiration. The CT impression read Possible interval development of ascites vs. abscess vs. fluid collection. The results from the fluid aspirated had no growth. Would you assign an Organ/Space SSI to this case NSWER & RTIONLE You would assign the post-operative occurrence of Organ/Space SSI to this case. There was documentation of a possible abscess on the CT impression in the space that was manipulated during surgery. Please remember modifying words meet criteria to assign the post-operative occurrence.
6 Organ/Space SSI and PTOS You are reviewing a case where the patient arrives to the OR with a perforated bowel. fter a bowel resection and abdominal wash-out, the surgeon chooses to leave the abdominal incision open and place a wound vac directly on the bowel. POD 2 the patient returns to the operating room for an abdominal washout, and wound vac exchange. During the RTOR the doctor notes purulence in the abdominal cavity and the OR nurse assigned a wound class 4 to the case. In regards to the post-operative occurrence of Organ/Space SSI and Organ/Space SSI PTOS, what would you assign to this case C D You would not assign the post-operative occurrence of Organ/Space SSI or Organ/Space SSI PTOS You would assign the post-operative occurrence of Organ/Space SSI but not Organ/Space SSI PTOS You would assign the post-operative occurrence of Organ/Space and Organ/Space SSI PTOS You would only assign Organ/Space SSI PTOS
7 Organ/Space SSI and PTOS You are reviewing a case where the patient arrives to the OR with a perforated bowel. fter a bowel resection and abdominal wash-out, the surgeon chooses to leave the abdominal incision open and place a wound vac directly on the bowel. POD 2 the patient returns to the operating room for an abdominal washout, and wound vac exchange. During the RTOR the doctor notes purulence in the abdominal cavity and the OR nurse assigned a wound class 4 to the case. In regards to the post-operative occurrence of Organ/Space SSI and Organ/Space SSI PTOS, what would you assign to this case NSWER & RTIONLE You would not assign the post-operative occurrence of Organ/Space SSI or Organ/Space SSI PTOS You would not assign an SSI to a wound that was left open. n SSI is only assigned at or below the level of closure. lso, a wound vac is similar to a dressing and not considered a type of surgical wound closure. If you do not assign the postoperative occurrence of Organ/Space SSI, you would not assess for Organ/Space SSI PTOS.
8 Sepsis and Sepsis PTOS Patient arrives in the ER and is worked up for a suspected ruptured appendix. You are unable to find documentation of preoperative vital signs. The patient is taken to the OR for a laparoscopic appendectomy. The doctor s operative dictation confirms the appendix was inflamed and ruptured. In PCU, the patient HR is bpm and RR of ll other vital signs are within normal limits. In regards to the post-operative occurrence of Sepsis and Sepsis PTOS, what would you assign to this case C D You would not assign the post-operative occurrence of Sepsis or Sepsis PTOS You would assign the post-operative occurrence of Sepsis but not Sepsis PTOS You would assign the post-operative occurrence of Sepsis and Sepsis PTOS You would only assign Sepsis PTOS to this case
9 ORGN/SPCE SSI Patient arrives in the ER and is worked up for a suspected ruptured appendix. You are unable to find documentation of preoperative vital signs. The patient is taken to the OR for a laparoscopic appendectomy. The doctor s operative dictation confirms the appendix was inflamed and ruptured. In PCU, the patient HR is bpm and RR of ll other vital signs are within normal limits. In regards to the post-operative occurrence of Sepsis and Sepsis PTOS, what would you assign to this case NSWER & RTIONLE C You would assign the post-operative occurrence of Sepsis and Sepsis PTOS to this case Post-operative Sepsis is assigned as SIRS criteria are met with pulse of 95 bpm and RR of 21 and a ruptured appendix would constitute purulence in the operative site. Sepsis PTOS is assigned as the doctor s operative dictation that the appendix was inflamed and ruptured is highly suggestive or suspicious of sepsis at the time of surgery.
10 UTI and UTI PTOS patient arrives to Same Day Surgery for an elective procedure. The patient tells the Same Day Surgery nurse she has been experiencing painful urination for 2 days. The nurse notifies the surgery resident who orders a pre-operative urine culture. The patient goes to surgery without delay. On POD 1 the urine culture comes back with greater than 100,000 colonies/ml of a single pathogen. There are no other criteria noted post-operatively. In regards to the post-operative occurrence of UTI and UTI PTOS, what would you assign to this case You would not assign the post-operative occurrence of UTI C D You would assign the post-operative occurrence of UTI You would assign the post-operative occurrence of UTI and UTI PTOS to this case You would only assign UTI PTOS to this case
11 UTI and UTI PTOS patient arrives to Same Day Surgery for an elective procedure. The patient tells the Same Day Surgery nurse she has been experiencing painful urination for 2 days. The nurse notifies the surgery resident who orders a pre-operative urine culture. The patient goes to surgery without delay. On POD 1 the urine culture comes back with greater than 100,000 colonies/ml of a single pathogen. There are no other criteria noted post-operatively. In regards to the post-operative occurrence of UTI and UTI PTOS, what would you assign to this case NSWER & RTIONLE You would not assign the post-operative occurrence of UTI The pre-operative symptoms and culture positive urine collection cannot be utilized to assign the post-operative occurrence of UTI. s the post-operative occurrence of UTI is not assigned, PTOS would not be assessed.
12 Pneumonia and Pneumonia PTOS Pre-operatively, the patient s H&P does not report any underlying pulmonary or cardiac disease; however the pre-operative chest CT showed pleural effusion with consolidation. The patient is emergently taken to the OR for necrotic small bowel and perforation and underwent small bowel resection. Post-operatively, the daily post-op CXRs document opacity, effusion and consolidations. On POD 1 a chest tube was placed at the bedside. pleural fluid culture was taken at the time of the chest tube placement and returned positive for E coli. Physician documentation indicates that the E coli pleural fluid is a sympathetic collection from the abdominal process. On POD 1 the patient has leukopenia with WC of 3.8 Would you assign the post-operative occurrence of Pneumonia and Pneumonia PTOS to this case You would not assign the post-operative occurrence of Pneumonia or Pneumonia PTOS C D You would assign the post-operative occurrence of Pneumonia but not Pneumonia PTOS You would assign the post-operative occurrence of Pneumonia and Pneumonia PTOS You would only assign Pneumonia PTOS to this case
13 Pneumonia and Pneumonia PTOS Pre-operatively, the patient s H&P does not report any underlying pulmonary or cardiac disease; however the pre-operative chest CT showed pleural effusion with consolidation. The patient is emergently taken to the OR for necrotic small bowel and perforation and underwent small bowel resection. Post-operatively, the daily post-op CXRs document opacity, effusion and consolidations. On POD 1 a chest tube was placed at the bedside. pleural fluid culture was taken at the time of the chest tube placement and returned positive for E coli. Physician documentation indicates that the E coli pleural fluid is a sympathetic collection from the abdominal process. On POD 1 the patient has leukopenia with WC of 3.8 Would you assign the post-operative occurrence of Pneumonia and Pneumonia PTOS to this case NSWER & RTIONLE C You would assign the post-operative occurrence of Pneumonia and Pneumonia PTOS to this case Radiologic criteria is met with documentation of opacity and consolidations on the daily postoperative CXR. Signs/Symptoms/Lab criteria are met with leukopenia/ WC of 3.8 and the pleural fluid culture which was positive for E coli. Pneumonia PTOS would be assigned as the post-operative occurrence of Pneumonia is assigned and the pre-operative chest CT showed pleural effusion with consolidation, which is highly suggestive or suspicious of Pneumonia.
14 Intraoperative or Postoperative Myocardial Infarction The patient in the case you are reviewing has elevated troponins 10 times your hospitals reference range on POD 2. Cardiology is consulted and the patient is diagnosed with demand ischemia. Would you assign the post-operative occurrence of Intraoperative or Postoperative Myocardial Infarction to this case Yes, you would assign the post-operative occurrence of Intraoperative or Postoperative Myocardial Infarction to this case No, you would not assign the post-operative occurrence of Intraoperative or Postoperative Myocardial Infarction to this case
15 Intraoperative or Postoperative Myocardial Infarction The patient in the case you are reviewing has elevated troponins 10 times your hospitals reference range on POD 2. Cardiology is consulted and the patient is diagnosed with demand ischemia. Would you assign the post-operative occurrence of Intraoperative or Postoperative Myocardial Infarction to this case NSWER & RTIONLE Yes, you would assign the post-operative occurrence of Intraoperative or Postoperative Myocardial Infarction to this case Elevated troponins greater than 3 times the hospital s upper level reference range in the presence of suspected myocardial ischemia. The documentation of troponins and demand ischemia per cardiology meet criteria to assign the variable.
16 Wound Class In general, pathology results are not available until after the patient leaves OR. Can you use results which are not available during the intra-operative period to assign wound class Yes No
17 Wound Class In general, pathology results are not available until after the patient leaves OR. Can you use results which are not available during the intra-operative period to assign wound class NSWER & RTIONLE No Wound classification is assigned at time of the principal operative procedure; therefore post-operative information would not be used for this designation.
18 Case Inclusion patient has a planned breast biopsy and was discharged home on the same day. You included the case in your sampling for cycle 25. The same patient returned to your OR for a planned vascular surgery, which comes up for review in your sampling for cycle 27. Would you include the vascular procedure in your sampling as a new principal operative procedure Yes, you would include the vascular case in your sampling No, you would not include the vascular case in your sampling
19 Case Inclusion patient has a planned breast biopsy and was discharged home on the same day. You included the case in your sampling for cycle 25. The same patient returned to your OR for a planned vascular surgery, which comes up for review in your sampling for cycle 27. Would you include the vascular procedure in your sampling as a new principal operative procedure NSWER & RTIONLE No, you would not include the vascular case in your sampling. You would not assess more than one case per patient in a 30 day period.
20 UTI 75 year old woman had an anterior resection 2 days ago, which you are reviewing. She develops fever, abdominal pain and has not had a bowel movement since surgery. She also has an indwelling urinary catheter. Her heart rate is 95 beats per minute, RR of 26 and her temperature is 38.3 C. CT of the abdomen is negative. urine culture came back positive for 3 organisms all greater than 100,000 colonies/ml. The surgical resident documents the positive urine culture is causative of the fever, elevated heart rate and respirations. Would you assign the post-operative occurrence of UTI to this case Yes, you would assign the post-operative occurrence of UTI to this case No, you would not assign the post-operative occurrence of UTI to this case
21 UTI 75 year old woman had an anterior resection 2 days ago, which you are reviewing. She develops fever, abdominal pain and has not had a bowel movement since surgery. She also has an indwelling urinary catheter. Her heart rate is 95 beats per minute, RR of 26 and her temperature is 38.3 C. CT of the abdomen is negative. urine culture came back positive for 3 organisms all greater than 100,000 colonies/ml. The surgical resident documents the positive urine culture is causative of the fever, elevated heart rate and respirations. Would you assign the post-operative occurrence of UTI to this case NSWER & RTIONLE No, you would not assign the post-operative occurrence of UTI to this case The urine culture does not meet criteria to assign the variable as it is positive for more than 2 species of organisms.
22 Elective Surgery, Patient Coming from Home You have selected an inguinal hernia repair for review. The patient s history shows that the general surgeon scheduled the patient for surgery three weeks ago and ordered him to be admitted the day before surgery to d/c the patient s chronic Coumadin therapy and to start the patient on Heparin. Would you assign the pre-operative variable of Elective Surgery, Patient Coming from Home to this case Yes, you would assign the pre-operative variable of Elective Surgery, Patient Coming from Home to this case No, you would not assign the pre-operative variable of Elective Surgery, Patient Coming from Home to this case
23 Elective Surgery, Patient Coming from Home You have selected an inguinal hernia repair for review. The patient s history shows that the general surgeon scheduled the patient for surgery three weeks ago and ordered him to be admitted the day before surgery to d/c the patient s chronic Coumadin therapy and to start the patient on Heparin. Would you assign the pre-operative variable of Elective Surgery, Patient Coming from Home to this case NSWER & RTIONLE No, you would not assign the pre-operative variable of Elective Surgery, Patient Coming from Home to this case This variable does not apply to patients who are admitted to the hospital for any period of time prior to going to the OR for any reason.
24 Septic Shock and Septic Shock PTOS patient arrives to your ER meeting SIRS criteria. The patient s blood pressure drops and he is placed on a vasopressor. The patient is diagnosed with ischemic bowel and is taken to the OR for an emergency bowel resection. The patient was intubated, prepped, draped and an incision was made. s the surgeon placed the abdominal retractor, the patient arrested. The patient was stabilized, the retractor was removed and only skin was closed. The patient was taken to the ICU for further stabilization prior to a return to the OR for the bowel resection. In the ICU the patient remains intubated, on vasopressors with a HR of 102 and WC s of 20. In regards to the post-operative occurrence of Septic Shock and Septic Shock PTOS, what would you assign to this case C D You would not assign the post-operative occurrence of Septic Shock or Septic Shock PTOS You would assign the post-operative occurrence of Septic Shock but not Septic Shock PTOS You would assign the post-operative occurrence of Septic Shock and Septic Shock PTOS You would only assign Septic Shock PTOS to this case
25 Septic Shock and Septic Shock PTOS patient arrives to your ER meeting SIRS criteria. The patient s blood pressure drops and he is placed on a vasopressor. The patient is diagnosed with ischemic bowel and is taken to the OR for an emergency bowel resection. The patient was intubated, prepped, draped and an incision was made. s the surgeon placed the abdominal retractor, the patient arrested. The patient was stabilized, the retractor was removed and only skin was closed. The patient was taken to the ICU for further stabilization prior to a return to the OR for the bowel resection. In the ICU the patient remains intubated, on vasopressors with a HR of 102 and WC s of 20. In regards to the post-operative occurrence of Septic Shock and Septic Shock PTOS, what would you assign to this case NSWER & RTIONLE C You would assign the post-operative occurrence of Septic Shock and Septic Shock PTOS to this case Post-operative SIRS criteria is met with a HR of 102 and WC s of 20. Sepsis criteria is met with a diagnosis of an ischemic bowel requiring resection, and septic shock criteria is met with the requirement of vasopressors due to hypotension. Septic shock PTOS is assigned as the patient met SIRS criteria and was placed on a vasopressor due to hypotension pre-operatively.
26 Sepsis 75 year old woman had an anterior resection 2 days ago, which you are reviewing. She develops fever, abdominal pain and has not had a bowel movement since surgery. She also has an indwelling urinary catheter. Her heart rate is 95 beats per minute, RR of 26 and her temperature is 38.3 C. CT of the abdomen is negative. urine culture came back positive for 3 organisms all greater than 100,000 colonies/ml. The surgical resident documents the positive urine culture is causative of the fever, elevated heart rate and respirations. Would you assign the post-operative occurrence of Sepsis to this case Yes, you would assign the post-operative occurrence of Sepsis to this case No, you would not assign the post-operative occurrence of Sepsis to this case
27 Sepsis 75 year old woman had an anterior resection 2 days ago, which you are reviewing. She develops fever, abdominal pain and has not had a bowel movement since surgery. She also has an indwelling urinary catheter. Her heart rate is 95 beats per minute, RR of 26 and her temperature is 38.3 C. CT of the abdomen is negative. urine culture came back positive for 3 organisms all greater than 100,000 colonies/ml. The surgical resident documents the positive urine culture is causative of the fever, elevated heart rate and respirations. Would you assign the post-operative occurrence of Sepsis to this case NSWER & RTIONLE Yes, you would assign the post-operative occurrence of Sepsis to this case SIRS criteria are met with the temperature, heart rate, and respiratory rate. The resident s documentation of the positive urine culture being causative of the fever, heart rate and respiratory rate is correlation by a physician that the site is the acute cause of the septic picture.
28 Deep SSI and Deep SSI PTOS patient you are reviewing had lysis of adhesions with no noted intraabdominal infection/contamination. On POD 2 feculent material is noted draining from the incision site. The patient is taken back to the OR where an inadvertent enterotomy from the lysis of adhesions was discovered. In regards to the post-operative occurrence of Deep SSI and Deep SSI PTOS, what would you assign to this case C D You would not assign the post-operative occurrence of Deep SSI or Deep SSI PTOS You would assign the post-operative occurrence of Deep SSI but no Deep SSI PTOS You would assign the post-operative occurrence of Deep SSI and Deep SSI PTOS You would only assign Deep SSI PTOS to this case
29 Deep SSI and Deep SSI PTOS patient you are reviewing had lysis of adhesions with no noted intraabdominal infection/contamination. On POD 2 feculent material is noted draining from the incision site. The patient is taken back to the OR where an inadvertent enterotomy from the lysis of adhesions was discovered. In regards to the post-operative occurrence of Deep SSI and Deep SSI PTOS, what would you assign to this case NSWER & RTIONLE You would assign the post-operative occurrence of Deep SSI but no Deep SSI PTOS You would report an Organ/Space infection that drains through the incision as Deep Incisional SSI. You would not assign Deep Incisional SSI PTOS as the enterotomy, which caused the infection, occurred intra-operatively and was not present when the patient entered the operating room.
30 Case Inclusion patient was scheduled to have an bdominal ortic neurysm repair. Upon entering the OR the patient became hypotensive during anesthesia induction and the surgery was cancelled. Would you include this case in your sampling Yes, you would include this case in your sampling No, you would not include this case in your sampling
31 Case Inclusion patient was scheduled to have an bdominal ortic neurysm repair. Upon entering the OR the patient became hypotensive during anesthesia induction and the surgery was cancelled. Would you include this case in your sampling NSWER & RTIONLE No, you would not include this case in your sampling s the surgery was cancelled before a surgical incision was made, you would not include it in your sampling.
32 Case Inclusion 21yr old female arrives to your ER with 3rd degree burns from the industrial oven at work. The patient is discharged from her initial burn visit. She returns for a skin graft to the burn area. The skin graft case is up for selection on your operative log. Would you exclude this case as a trauma Yes, this case meets NSQIP trauma criteria and would be excluded from sampling No, this case does not meet NSQIP trauma criteria and would be included if all systematic sampling criteria are met
33 Case Inclusion 21yr old female arrives to your ER with 3rd degree burns from the industrial oven at work. The patient is discharged from her initial burn visit. She returns for a skin graft to the burn area. The skin graft case is up for selection on your operative log. Would you exclude this case as a trauma NSWER & RTIONLE No, this case does not meet NSQIP trauma criteria and would be included if all systematic sampling criteria are met s the patient was discharged from the initial burn (trauma) visit, you would include the case if all other NSQIP systematic sampling criteria are met.
34 Septic Shock patient arrives to your ER meeting SIRS criteria. The patient s blood pressure drops and he is placed on a vasopressor. The patient is diagnosed with an ischemic bowel and is taken to the OR for an emergent bowel resection. The patient was intubated, prepped, draped and an incision was made. s the surgeon placed the abdominal retractor, the patient arrested. The patient was stabilized, the retractor was removed and only skin was closed. The patient was taken to the ICU for further stabilization prior to a return to the OR for the bowel resection. In the ICU the patient remains intubated, on vasopressors with a HR of 102 and WC s of 20. Would you assign the pre-operative risk factor of Septic Shock to this case Yes, you would assign the pre-operative risk factor of Septic Shock to this case No, you would not assign the pre-operative risk factor of Septic Shock to this case
35 Septic Shock patient arrives to your ER meeting SIRS criteria. The patient s blood pressure drops and he is placed on a vasopressor. The patient is diagnosed with an ischemic bowel and is taken to the OR for an emergent bowel resection. The patient was intubated, prepped, draped and an incision was made. s the surgeon placed the abdominal retractor, the patient arrested. The patient was stabilized, the retractor was removed and only skin was closed. The patient was taken to the ICU for further stabilization prior to a return to the OR for the bowel resection. In the ICU the patient remains intubated, on vasopressors with a HR of 102 and WC s of 20. Would you assign the preoperative risk factor of Septic Shock to this case NSWER & RTIONLE Yes, you would assign the pre-operative risk factor of Septic Shock to this case Prior to the principal operative procedure, the patient met SIRS criteria, required a bowel resection for ischemic bowel, and was placed on a vasopressor preoperatively due to hypotension (considered organ dysfunction).
36 Ventilator Dependent 35 year old morbidly obese patient arrives to your ER with a small bowel obstruction. The patient is admitted to a floor in your hospital and is placed on the vent with CPP setting at night to maintain his airway. The next day it is determined that medical management is not resolving the bowel obstruction, and the patient is taken to the OR. The patient remains in the hospital for 8 days post-operatively. The patient is on the vent each night for 8 hours. The only setting on the vent is CPP. Would you assign the pre-operative risk factor of Ventilator Dependent to this case Yes, you would assign the pre-operative risk factor of Ventilator Dependent to this case No, you would not assign the pre-operative risk factor of Ventilator Dependent to this case
37 Ventilator Dependent 35 year old morbidly obese patient arrives to your ER with a small bowel obstruction. The patient is admitted to a floor in your hospital and is placed on the vent with CPP setting at night to maintain his airway. The next day it is determined that medical management is not resolving the bowel obstruction, and the patient is taken to the OR. The patient remains in the hospital for 8 days post-operatively. The patient is on the vent each night for 8 hours. The only setting on the vent is CPP. Would you assign the pre-operative risk factor of Ventilator Dependent to this case NSWER & RTIONLE No, you would not assign the pre-operative risk factor of Ventilator Dependent to this case You would not assign the variable when a patient is only on the CPP setting.
38 35 year old morbidly obese patient arrives to your ER with a small bowel obstruction. The patient is admitted to a floor in your hospital and is placed on the vent with CPP setting at night to maintain his airway. The next day it is determined that medical management is not resolving the bowel obstruction, and the patient is taken to the OR. The patient remains in the hospital for 8 days post-operatively. The patient is on the vent each night for 7 nights, 8 hours a night. The vent setting is CPP. On Ventilator > 48 hours and On Ventilator > 48 hours PTOS In regards to the post-operative occurrence of On Ventilator > 48 hours and On Ventilator > 48 hours PTOS, what would you assign to this case You would not assign the post-operative occurrence of On Ventilator > 48 hours or On Ventilator >48 hours PTOS C D You would assign the post-operative occurrence of On Ventilator > 48 hours but not On Ventilator >48 hours PTOS You would assign the post-operative occurrence of On Ventilator > 48 hours and On Ventilator > 48 hours PTOS. You would only assign On Ventilator > 48 hours PTOS to this case.
39 On Ventilator > 48 hours and On Ventilator > 48 hours PTOS 35 year old morbidly obese patient arrives to your ER with a small bowel obstruction. The patient is admitted to a floor in your hospital and is placed on the vent with CPP setting at night to maintain his airway. The next day it is determined that medical management is not resolving the bowel obstruction, and the patient is taken to the OR. The patient remains in the hospital for 8 days post-operatively. The patient is on the vent each night for 7 nights, 8 hours a night. The vent setting is CPP. In regards to the post-operative occurrence of On Ventilator > 48 hours and On Ventilator > 48 hours PTOS, what would you assign to this case NSWER & RTIONLE You would not assign the post-operative occurrence of On Ventilator > 48 hours or On Ventilator > 48 hours PTOS You would not assign the variable when a patient is only on the CPP setting.
40 Wound Disruption patient with a complex recurrent incisional hernia repair requiring mesh and component separation was readmitted with an SSI on POD 20. The incision was noted to be intact. n abdominal CT was ordered which revealed "Open wound on the anterior abdominal wall overlying a large ventral midline hernia sac containing mesenteric fat and non-obstructed bowel. Would you assign the post-operative occurrence of wound disruption to this case Yes, you would assign the post-operative occurrence of wound disruption to this case No, you would not assign the post-operative occurrence of wound disruption to this case
41 Wound Disruption patient with a complex recurrent incisional hernia repair requiring mesh and component separation was readmitted with an SSI on POD 20. The incision was noted to be intact. n abdominal CT was ordered which revealed "Open wound on the anterior abdominal wall overlying a large ventral midline hernia sac containing mesenteric fat and non-obstructed bowel. Would you assign the post-operative occurrence of wound disruption to this case NSWER & RTIONLE Yes, you would assign the post-operative occurrence of wound disruption to this case The open wound on the anterior abdominal wall overlying a large ventral midline hernia sac containing mesenteric fat and non-obstructed bowel would be considered a breakdown of the surgical closure compromising the integrity of the procedure.
42 Organ/Space SSI The patient you are reviewing had a fem-pop bypass. On POD 1, nursing notes the patient is complaining of intense itching at the site of his femoral incision. When the dressing is changed, the patient s incision is noted to be mildly red and the incision site is intact with a moderate amount of serous drainage. On post-op day 2, nursing notes document that the patient is stating the incision is now tender and burning. When the dressing is changed a small amount of purulent drainage is noted. n aseptically obtained culture of the superficial incision is obtained before redressing. The culture does not grow any organisms. Would you assign an Organ/Space SSI to this case You would assign the post-operative occurrence of Organ/Space SSI to this case You would not assign the post-operative occurrence of Organ/Space SSI to this case
43 Organ/Space SSI The patient you are reviewing had a fem-pop bypass. On POD 1, nursing notes the patient is complaining of intense itching at the site of his femoral incision. When the dressing is changed, the patient s incision is noted to be mildly red and the incision site is intact with a moderate amount of serous drainage. On post-op day 2, nursing notes document that the patient is stating the incision is now tender and burning. When the dressing is changed a small amount of purulent drainage is noted. n aseptically obtained culture of the superficial incision is obtained before redressing. The culture does not grow any organisms. Would you assign an Organ/Space SSI to this case NSWER & RTIONLE You would not assign the post-operative occurrence of Organ/Space SSI to this case The purulent drainage from the incision would meet criteria to assign a Superficial Incisional SSI, but there is no information provided that suggests an SSI at the Organ/Space level.
44 Organ/Space SSI patient who had a colon procedure at your site is discharged on POD 7. Twenty-four hours after discharge, the patient returns to your emergency department complaining of voluminous watery diarrhea every 1-2 hours. C Diff DN test returns positive. No other symptoms are noted. The patient is treated with IV fluids and Flagyl. Would you assign an Organ/Space SSI to this case Yes, you would assign the post-operative occurrence of Organ/Space SSI to this case No, you would not assign the post-operative occurrence of Organ/Space SSI to this case
45 Organ/Space SSI patient who had a colon procedure at your site is discharged on POD 7. Twenty-four hours after discharge, the patient returns to your emergency department complaining of voluminous watery diarrhea every 1-2 hours. C Diff DN test returns positive. No other symptoms are noted. The patient is treated with IV fluids and Flagyl. Would you assign an Organ/Space SSI to this case NSWER & RTIONLE You would not assign the post-operative occurrence of Organ/Space SSI to this case positive C Diff DN test alone, with no other specified criteria, would not meet criteria to assign a postoperative SSI.
46 Wound Class You are abstracting a small bowel resection. The doctor documents no inflammation or infection was seen upon entering the abdomen. The OR staff documents the wound class as clean. What wound class would you document in the NSQIP workstation C D Clean Clean/Contaminated Contaminated Dirty/Infected
47 Wound Class You are abstracting a small bowel resection. The doctor documents no inflammation or infection was seen upon entering the abdomen. The OR staff documents the wound class as clean. What wound class would you document in the NSQIP workstation NSWER & RTIONLE Clean/Contaminated This is an operative wound in which the alimentary canal is entered under controlled conditions without unusual contamination.
48 SSI You have abstracted a case where the patient returns to the ED on POD 15, with purulent drainage from the surgical site. The ED doctor diagnoses the patient with an SSI and prescribes antibiotics. On POD 16, the surgeon sees the patient in the office and documents that the incision is clean/dry and intact. Would you assign a post-operative SSI to this case Yes, you would assign a post-operative occurrence of SSI to this case No, you would not assign a post-operative occurrence of SSI to this case
49 SSI You have abstracted a case where the patient returns to the ED on POD 15, with purulent drainage from the surgical site. The ED doctor diagnoses the patient with an SSI and prescribes antibiotics. On, POD 16, the surgeon sees the patient in the office and documents that the incision is clean/dry and intact. Would you assign a post-operative SSI to this case NSWER & RTIONLE Yes, you would assign a post-operative occurrence of SSI to this case. There is a physician diagnosis of an SSI as well as documentation of purulent drainage from the surgical site.
50 Stroke/Cerebral Vascular ccident (CV) There was a repair included in your sampling. The patient expires on POD 25 and the immediate cause of death is listed as a cerebrovascular infarction. Would you assign the post-operative occurrence of Stroke/Cerebral Vascular ccident (CV) to this case Yes, you would assign the post-operative occurrence of Stroke/Cerebral Vascular ccident (CV)to this case No, you would not assign the post-operative occurrence of Stroke/Cerebral Vascular ccident (CV) to this case
51 Stroke/Cerebral Vascular ccident (CV) There was a repair included in your sampling. The patient expires on POD 25 and the immediate cause of death is listed as a cerebrovascular infarction. Would you assign the post-operative occurrence of Stroke/Cerebral Vascular ccident (CV) to this case NSWER & RTIONLE Yes, you would assign the post-operative occurrence of Stroke/Cerebral Vascular ccident (CV) to this case There is a diagnosis of a CV documented in the 30 day post-operative period, therefore it would be assigned.
52 Thank You. We appreciate your participation, dedication, and feedback.
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