MBSAQIP Complex Clinical Scenarios & Variable Review

Transcription

1 MBSAQIP Complex Clinical Scenarios & Variable Review

2 Disclosure The following planners, speakers, moderators, and/or panelists of the CME/CEU activity have no relevant financial relationships with commercial interest to disclose: Lisa Hale, MSN, RN, CNOR

3 The patient in the case you are reviewing has a diagnosis of diabetes mellitus and has been taking Victoza (liraglutide) injections for the 30 days prior to the metabolic or bariatric procedure. You assigned Diabetes Mellitus Requiring Therapy with Non-Insulin Agents or Insulin to the case. Which option would you assign? Non-insulin Insulin Question 1

4 Non-Insulin Question 1- Answer

5 Patient has a history of multiple umbilical hernia repairs prior to the metabolic or bariatric surgery. Based on this information, would you assign the preoperative risk factor of Previous Obesity Surgery/Foregut Surgery? Yes No Question 2

6 Question 2- Answer No, this would be considered a Previous Obesity Surgery/Foregut Surgery

7 In the preoperative history and physical prior to a laparoscopic sleeve gastrectomy, you note that the patient has a history of a Nissen fundoplication. Would you assign the preoperative risk factor of Previous Obesity Surgery/Foregut Surgery to this case? Yes No Question 3

8 Question 3- Answer Yes, this would be considered a Previous Obesity Surgery/Foregut Surgery

9 You are reviewing the operative report for a sleeve gastrectomy and note that there was documentation of sequential firings of the black load Endo-GIA type stapler with buttressing. What would you assign for Staple Line Reinforcement? Yes No Question 4

10 Question 4- Answer Yes, this would be considered Staple Line Reinforcement

11 Question 5 You are completing 2 year follow-up on a patient with a history of a laparoscopic sleeve gastrectomy on 11/07/2014. You note that within the 2 year follow-up timeframe, on 3/2/2017, the patient had an EGD with balloon dilation of the gastrojejunostomy in the Endoscopy suite. Which of the following is correct for this case? Capture the EGD with balloon dilation as an intervention on the 2 year follow-up form and as a new case in the data registry Capture the EGD with balloon dilation as an intervention on the 2 year follow-up form only Capture the EGD with balloon dilation as a new case in the data registry only You would not capture the EGD with balloon dilation in the data registry

12 Question 5- Answer Capture the EGD with balloon dilation as an intervention on the 2 year follow-up form only

13 Question 6 The patient in the case that you are reviewing as seen in the emergency department on postoperative day 24 and admitted as observation for non-specific abdominal pain. The patient stayed 1 night in observation and was discharged on postoperative day 25. What would be captured for this case? Hospital Readmission within 30 days of the principal procedure Emergency Department (ED) which did not result in an Inpatient Admission Neither of these Both options would be assigned

14 Question 6- Answer Emergency Department (ED) which did not result in an Inpatient Admission

15 The patient is noted to have an IVC filter removed on postoperative day 20 in the cath lab. The patient received moderate sedation for the case. What would you capture this as? A reoperation An intervention Question 7

16 An intervention Question 7- Answer

17 Question 8 The patient in the case that you are reviewing was seen in the emergency department on postoperative day 10 and readmitted due to nausea. The patient stayed 1 night as an inpatient and was discharged on postoperative day 11. What would be captured for this case? Hospital Readmission within 30 days of the principal procedure Emergency Department (ED) which did not result in an Inpatient Admission Neither of these Both options would be assigned

18 Question 8- Answer Hospital Readmission within 30 days of the principal procedure

19 The patient in the case you are reviewing had a conversion of a roux-en-y gastric bypass to a biliopancreatic diversion with duodenal switch. On postoperative day 5, the patient is noted to be septic due to an anastomotic leak. The patient is taken to the operating room for a repair of the leak. It is decided that the patient will be admitted to the ICU following the reoperation. In this scenario, would you assign Unplanned Admission to ICU? Yes No Question 9

20 Question 9- Answer Yes, this would be considered an unplanned admission to ICU

21 You are reviewing documentation for a case and find that the patient called and reported pus at the surgical site to the surgeon on postoperative day 32. The patient stated during the call that they noticed the pus the day before. What postoperative occurrence would you assign to this case? Superficial Incisional SSI Deep Incisional SSI Organ/Space SSI None Question 10

22 Question 10- Answer None as criteria was not met to assign a postoperative SSI occurrence

23 You are abstracting a case with a gastric bypass with roux-en-y as the principal operative procedure. During the operation, there was an inadvertent enterotomy with spillage of enteric contents into the abdomen. On postoperative day 1, the patient is noted to have a heart rate of 105 and a WBC of Which postoperative occurrence would you assign to this case? Sepsis Sepsis with PATOS Septic Shock Septic Shock with PATOS None Question 11

24 Question 11- Answer The postoperative occurrence of Sepsis would be assigned to this case

25 Question 12 A patient presents to your site for a hiatal hernia repair. They have a history of sleeve gastrectomy performed one year ago that was not done at your site. How would you capture this case in your data registry? Capture the hiatal hernia repair as a reoperation Capture the hiatal hernia repair as a new case Do not capture the hiatal hernia repair as the sleeve gastrectomy was not performed at your site Open a new case for the sleeve gastrectomy

26 Question 12- Answer Capture the hiatal hernia repair as a new case

27 Question 13 A patient that recently underwent a routine single anastomosis duodenal-ileal bypass with sleeve gastrectomy at your site. The patient presents to your ED on postoperative day 17 complaining of abdominal pain. The patient is taken to surgery for an exploratory laparotomy, during which the surgeon notes an anastomotic leak. With the information provided, what would you assign for this case? Organ/Space SSI would be assigned Organ/Space SSI with PATOS would be assigned Organ/Space SSI criteria were not met

28 Question 13- Answer Organ/Space SSI would be assigned

29 Question 14 You call a patient that is due for follow-up during the one year assessment time frame. The patient makes an appointment but does not show. Which question is most appropriate to answer Yes to the long term follow-up form? Is patient refusing long-term follow-up? Is the patient lost to follow-up? Was the patient's care transferred to another bariatric specialist? Was a follow-up appointment made but patient did not show for appointment?

30 Question 14- Answer Was a follow-up appointment made but patient did not show for appointment?

31 A patient was readmitted to hospital on postoperative day 3 for peritonitis and septic shock. On the same day, the patient went back to the OR and was intubated for a diagnostic laparotomy and abdominal washout. After the procedure, the patient was left intubated and remained acutely ill. Would you assign Unplanned Intubation for the case? Yes No Question 15

32 Question 15- Answer No, this would not be considered an Unplanned Intubation

33 Question 16 The patient presents to your site for a scheduled intragastric balloon removal. The balloon was inserted at your site 6 months ago. Which action below is most appropriate for the MBSCR? Capture the balloon removal as an intervention on the 6 month follow-up form Open a new case for the balloon removal Capture the balloon removal as an intervention on the 6 month follow-up form and open a new case for the balloon removal Capture the balloon removal as a reoperation

34 Question 16- Answer Capture the balloon removal as an intervention on the 6 month follow-up form and open a new case for the balloon removal

35 Question 17 The patient presents to your site for an EGD for a suspected anastomotic ulcer during the 2 year follow-up timeframe. The patient had a gastric bypass with roux-en-y performed at your site two years ago. The results of the EGD were within normal limits. How would you capture this EGD in your data registry? Capture the EGD as an intervention on long term follow-up form Capture the EGD as a reoperation on the long term follow-up form Open a new case for the EGD Do not capture the EGD in the registry as the results were within normal limits

36 Question 17- Answer Do not capture the EGD in the registry as the results were within normal limits

37 During your 6 month long term follow-up review, you notice that the patient is taking a PPI medication prophylactically. You also notice that there is no diagnosis of GERD. What answer would you mark for Gastroesophageal Reflux Disease (GERD) Requiring Medication variable? Yes No Question 18

38 Question 18- Answer No, you would NOT assign Gastroesophageal Reflux Disease (GERD) Requiring Medication

39 The patient had a visit with the registered dietician at your site on postoperative day 45. All of the documentation was signed off by the bariatric surgeon. Would this qualify to answer Yes to Were you able to follow the patient for the full 30 days? Yes No Question 19

40 Question 19- Answer Yes, this would meet criteria for full 30 day follow-up

41 Question 20 During the 1 year follow-up timeframe, the patient did not have a visit with a bariatric provider. You do note, however, that the patient had a visit with their PCP at this time. What information would you capture from this visit? Assessment date Weight and comorbidity information Assessment date, weight, and comorbidity information None of the above

42 Question 20- Answer Weight and comorbidity information

43 The surgeon at your center is performing a sleeve gastrectomy on a patient with a history of a gastric band placement and removal. What would you mark for Revision/Conversion? Yes No Question 21

44 Question 21- Answer Yes - This would be considered a Revision/Conversion

45 Question 22 Your patient visited the center twice within 1 year at the program. Weight during their first visit at the center was recorded as 325 lbs. 1 week before their procedure; the weight was recorded as 330 lbs. at the center. On the day of their procedure, at the hospital, the patient's weight was recorded as 335 lbs. You would capture: 325 lbs.as the Highest Recorded Weight within 1 year at the Program and 335 lbs. as Weight Closest to Surgery 325 lbs.as the Highest Recorded Weight within 1 year at the Program and 330 lbs. as Weight Closest to Surgery 335 lbs.as the Highest Recorded Weight within 1 year at the Program and 335 lbs. as Weight Closest to Surgery 330 lbs.as the Highest Recorded Weight within 1 year at the Program and 335 lbs. as Weight Closest to Surgery

46 Question 22- Answer 335 lbs.as the Highest Recorded Weight within 1 year at the Program and 335 lbs. as Weight Closest to Surgery

47 Question 23 Patient had a sleeve gastrectomy at your site. On postoperative day 23, the patient arrives to the ED complaining of urinary urgency. A urine culture is performed and shows < 100,000 colonies/ml of E.coli and < 10,000 mixed flora. A diagnosis of UTI is made and the patient is placed on ciprofloxacin. Which answer is most appropriate for this case? The postoperative occurrence of UTI would be assigned to this case The postoperative occurrence of UTI would NOT be assigned to this case as criteria were not met

48 Question 23- Answer The postoperative occurrence of UTI would NOT be assigned to this case as criteria were not met

49 Patient had a sleeve gastrectomy. On postoperative day 2 (50 hours postop), the patient had a blood transfusion. They received 5 units of PRBCs (volume: 350mL per unit). You would capture units of blood for Transfusion Intra/Postop (RBC within the First 72 Hrs of Surgery Start Time) in your data registry None Question 24

50 Question 24- Answer 5 units of blood for Transfusion Intra/Postop (RBC within the First 72 Hrs of Surgery Start Time)

51 Question 25 A patient was readmitted on postoperative day 15 after a mini-gastric bypass. During the readmission, the patient was assessed by the bariatric surgeon and discharged after a three day stay. The patient does not have any other visits with any provider until postoperative day 49. Which answer is most appropriate for this case? You would capture an assessment date based on physical assessment by the bariatric provider during the patient s readmission on discharge tab of the case form You would use the information from the readmission to meet full 30 day follow-up You would answer "Unknown" for the assessment date on the discharge tab of the case form You would capture the visit on postop day 49 as the assessment date on discharge tab of the case form

52 Question 25- Answer You would capture an assessment date based on physical assessment by the bariatric provider during the patient s readmission on discharge tab of the case form

53 Thank you