Departmental Segregated Total Form for General Surgery. American Osteopathic Association and the American College of Osteopathic Surgeons

Size: px

Start display at page:

Download "Departmental Segregated Total Form for General Surgery. American Osteopathic Association and the American College of Osteopathic Surgeons"

Adele Booker
5 years ago
Views:

1 Departmental Segregated Total Form for General Surgery American Osteopathic Association and the American College of Osteopathic Surgeons Revised, COPT 11/2001 Revised, BOT 2/2006, Effective, 7/2006

2 AMERICAN OSTEOPATHIC ASSOCIATION GENERAL SURGERY DEPARTMENTAL SEGREGATED TOTALS MAJOR PROCEDURES Base Institution: City: State: Program Director: Director of Medical Education: Training Year: Instructions: 1. This form must be completed and submitted with the required application documented by: Institutions with AOA Approved General Surgery residency training programs requesting an increase in the number of AOA-Approved Resident positions or, Institutions seeking approval of a new General Surgery residency training program. 2. Report only major procedures. (Multiple major procedures per patient may be reported.) 3. The mortality for each of the procedures listed must be reported on this form. 4. All information should reflect the procedures from July 1 to June 30 of the prior year. 5. Mail to: Residency Evaluation and Standards Committee (RESC), c/o American College of Osteopathic Surgeons, 123 North Henry Street, Alexandria, VA Total Major Procedures for Training Year: Specify the number of residents for the specialty below: General Surgery Residents Orthopedic Residents Urology Residents OB/GYN Residents General Vascular Residents Neurological Surgery Residents ENT Residents Cardiothoracic Vascular Residents Surgical Critical Care Residents 2

3 Procedures Mortalities I. SKIN AND SOFT TISSUE A. Major lymphadenectomy B. Excision of tissue for hydradenitis C. Excision of malignant lesion D. Sentinal lymph node biopsy for melanoma (SNLB) E. Radical excision of soft tissue tumor F. Other major skin and soft tissue surgery TOTAL PROCEDURES SECTION I II. HEAD AND NECK A. Excision of thyroglossal duct cyst B. Excision of brachial cleft cyst C. Lefort fracture reconstruction D. Other facial reconstruction E. Excision of salivary gland F. Laryngectomy with radical neck dissection G. Sinusotomy H. Tonsillectomy/adenoidectomy I. Other major head and neck surgery TOTAL PROCEDURES SECTION II III. PLASTICS A. Myocutaneous flap reconstruction B. Omental flap reconstruction C. Free flap reconstruction D. Split thickness skin graft E. Full thickness skin graft F. Application of allograft or xenograft G. Abdominoplasty/panniculectomy H. Facial augmentation procedure I. Other augmentation / contouring procedure J. Suction assisted lipectomy K. Other major plastic surgery TOTAL PROCEDURES SECTION III 3

4 IV. BREAST A. Simple mastectomy B. Subcutaneous mastectomy/skin sparing C. Modified radical mastectomy D. Radical mastectomy Procedures Mortalities E. Partial mastectomy with axillary lymphadenectomy F. Axillary lymphadenectomy G. Sentinal lymph node biopsy of axillary nodes (SLNB) H. Reduction mammaplasty I. Augmentation mammaplasty J. Breast reconstruction with tissue expander K. Breast reconstruction with TRAM flap L. Breast reconstruction with other flap M. Other major breast surgery TOTAL PROCEDURES SECTION IV V. ESOPHAGUS A. Partial esophagectomy B. Total esophagectomy C. Esophago-gastrectomy D. Nissen fundoplication (open) E. Nissen fundoplication (laparoscopic) F. Other antireflux procedure (abdominal approach) G. Esophageal bypass H. Repair of esophageal perforation (non-trauma) I. Esophageal diverticulectomy J. Other major esophageal surgery TOTAL PROCEDURES SECTION V VI. STOMACH A. Gastrostomy (open) B. Repair / oversew of gastric ulcer C. Partial gastric resection (open) D. Partial gastric resection (laparoscopic) E. Total gastric resection F. Vagotomy (truncal) with pyloroplasty G. Vagotomy (highly selective) with pyloroplasty H. Pyloroplasty I. Gastroduodenostomy (Billroth I) J. Gastrojejunostomy (Billroth II) K. Roux-en-Y gastrojejunostomy L. Billroth to Roux-en-Y conversion M. Pyloromyotomy (non-pediatric) N. Gastric bypass / bariatric surgery (open) O. Gastric bypass / bariatric surgery (laparoscopic) P. Other major gastric surgery TOTAL PROCEDURES SECTION VI 4

5 Procedures Mortalities VII. SMALL INTESTINE A. Enterolysis B. Small bowel resection C. Ileostomy D. Jejunostomy for enteral nutrition E. Small bowel enterorrhaphy F. Laparoscopic procedures 1. Enterolysis 2. Small bowel resection 3. Ileostomy 4. Enterorrhaphy G. Small bowel diverticulectomy (Meckel s) H. Repair / oversew of duodenal ulcer I. Small bowel sphincteroplasty J. Other major small bowel surgery TOTAL PROCEDURES SECTION VII VIII. LARGE INTESTINE A. Appendectomy (open) B. Appendectomy (laparoscopic) C. Hartmann s procedure D. Other colostomy E. Takedown (closure) colostomy F. Large bowel enterorrhaphy G. Right hemicolectomy H. Transverse hemicolectomy I. Left hemicolectomy J. Sigmoid colectomy K. Other partial colectomy (open) L. Laparoscopic colon resection M. Subtotal colectomy with ileostomy N. Abdominoperineal resection (APR) O. Low anterior resection (LAR) P. Proctocolectomy with ileostomy Q. Proctocolectomy with ileoproctostomy R. Proctocolectomy with ileoanal pull-thru S. Proctocolectomy with pouch reconstruction T. Cecostomy U. Other major large bowel surgery TOTAL PROCEDURES SECTION VIII 5

6 IX. ANUS / RECTUM A. Sphincterotomy / sphincteroplasty B. Transanal excision of rectal mass Procedures Mortalities C. Operations for rectal incontinence D. Repair of rectal prolapse E. Other major ano-rectal surgery TOTAL PROCEDURES SECTION IX X. BILIARY A. Cholecystostomy B. Cholecystectomy (open) 1. With cholangiogram 2. With common duct exploration 3. With choledochoscopy C. Laparoscopic cholecystectomy 1. With cholangiogram 2. With common duct exploration 3. With choledochoscopy D. Choledochoenteric anastomosis E. Repair of bile duct F. Sphincteroplasty (Oddi) G. Other major biliary surgery TOTAL PROCEDURES SECTION X XI. LIVER A. Lobectomy or segementectomy B. Wedge resection C. Hepatorrhaphy (non-trauma) D. Insertion hepatic artery infusion pump E. Liver biopsy (open) F. Liver biopsy (laparoscopic) G. Cryo-ablation of hepatic lesion H. Radiofrequency-ablation of hepatic lesion I. Other excision of hepatic lesion J. Drainage of liver abscess K. Other major liver surgery TOTAL PROCEDURES SECTION XI XII. PANCREAS A. Drainage of pancreatic abscess B. Resection for pancreatic necrosis C. Pancreatic debridement D. Local excision of pancreatic lesion E. Pancreatic cyst-gastrostomy F. Pancreatic cyst-jejunostomy 6

7 G. Other drainage of pancreatic cyst Procedures Mortalities H. Distal pancreatic resection I. Pancreaticoduodenectomy (Whipple) J. Other pancreatic resection K. Other major pancreatic surgery TOTAL PROCEDURES SECTION XII XIII. SPLEEN (non-trauma) A. Splenectomy (open) B. Splenectomy (laparoscopic) C. Partial splenectomy D. Splenorrhaphy E. Other major spleen surgery TOTAL PROCEDURES SECTION XIII XIV. ABDOMEN MISCELLANEOUS A. Exploratory laparotomy (non-trauma) B. Diagnostic laparoscopy (non-trauma) C. Drainage intra-abdominal abscess D. Retroperitoneal/pelvic lyphadenectomy E. Closure of disruption or evisceration F Placement peritoneal dialysis catheter (CAPD) G. Removal peritoneal dialysis catheter H. Other miscellaneous general abdominal surgery TOTAL PROCEDURES SECTION XIV 7

8 XV. HERNIA (adult only) A. Open herniorrhaphy 1. Open inguinal (unilateral) 2. Open inguinatl (bilateral) 3. Open femoral 4. Open ventral/umbilical 5. Open incisional 6. Diaphragmatic (non-trauma) 7. Other major open hernia surgery B. Laparoscopic herniorrhaphy 1. Laparoscopic extra-peritoneal inguinal (TEPA) 2. Laparoscopic intra-peritoneal inguinal (TAPP) 3. Laparoscopic ventral/umbilical 4. Other major laparoscopic hernia surgery TOTAL PROCEDURES SECTION XV Procedures Mortalities XVI. VASCULAR A. Vascular - Arterial 1. Aorto-iliac/femoral bypass 2. Ilio-iliac bypass 4. Axillo-femoral bypass 5. Axillo-popliteal-distal bypass 6. Femoral-popliteal bypass 7. Femoral-distal bypass 8. Popliteal-distal bypass 9. Re-do of extremity bypass 10. Revision of extremity bypass 11. Thrombectomy/embolectomy artery 12. Femoral/profunda endarterectomy 12. Peripheral artery angioplasty 14. Temporal artery biopsy 15. Celiac/SMA endarterectomy or bypass 16. Renal endarterectomy or bypass 17. Other major artery surgery B. Vascular - Aneurysm 1. Infrarenal aorto-iliac (AAA) elective 2. Infrarenal aorto-iliac (AAA) ruptured 3. Infrarenal aortic aneurysm (sleeve graft) 4. Suprarenal aortic aneurysm (AAA) 5. Thoracic aortic aneurysm 6. Thoraco-abdominal aortic aneurysm 7. Femoral artery aneurysm 8. Popliteal artery aneurysm 9. Other major aneurysm surgery 8

9 C. Vascular - Cerebrovascular 1. Carotid endarterectomy 2. Reoperative carotid surgery 3. Excision carotid body tumor 4. Vertebral artery surgery 5. Carotid-subclavian bypass 6. Other major cerebrovascular surgery D. Vascular - Amputation 1. Amputation, below knee (BKA) 2. Amputation, above knee (AKA) 3. Amputation, guillotine type 4. Amputation, stump revision 5. Amputation, transmetatarsal 6. Amputation, digit 7. Amputation, upper extremity 8. Other major amputation surgery E. Vascular - Venous 1. Ligation greater saphrenous vein 2. Varicose vein stripping/ligation 3. SEPS ligation of venous perforators Procedures Mortalities 4. Thrombectomy/embolectomy vein 5. Venous reconstruction 6. Repair A-V malformation 7. Porto-systemic shunt 8. Other major venous surgery F. Vascular Fistulas And Grafts 1. A-V fistula/graft creation 2. A-V fistula/graft revision 3. A-V fistula/graft thrombectomy 4. Excise infected graft 5. Repair graft-enteric fistula 6. Other major A-V fistula surgery G. Vascular Interventional And Endovascular 1. Endovascular repair aortic aneurysm 2. Endovascular conversion to open AAA 3. Other endovascular graft 4. Vena cava interruption / filter (Greenfield) 5. Balloon angioplasty peripheral artery 6. Balloon angioplasty with stent 7. Thrombolysis of peripheral artery 8. Other interventional / endovascular surgery TOTAL PROCEDURES SECTION XVI 9

10 XVII. CARDIOVASCULAR A. Coronary artery bypass graft (CABG) B. Cannulation for bypass C Peripheral vein/artery harvest D. Replacement of heart valve E. Repair of septal defect F. Repair congenital cardiac anomalies G. Cardiac pacemaker insertion H. Cardiac AICD insertion I. Intraaortic balloon pump insertion (IABP) J. Other major cardiovascular surgery TOTAL PROCEDURES SECTION XVII XVIII. THORACIC A. Exploratory thoracotomy (non-trauma) 1. Pneumonectomy 2. Radical pneumonectomy 3. Lobectomy/segmental lung resection 4. Wedge resection/biopsy lung 5. Decortication 6. Pleurodesis/pleurectomy 7. Drainage of empyema Procedures Mortalities B. Thorascopic surgery/vats (non-trauma) 1. Wedge resection/biopsy lung 2. Lobectomy/segmental lung resection 3. Decortication 4. Pleurodesis/pleurectomy 5. Drainage of empyema 6. Other major thorascopioc surgery TOTAL PROCEDURES SECTION XVIII XIX. ENDOCRINE A. Partial thyroid lobectomy B. Total thyroidectomy C. Other thyroidectomy D. Parathyroidectomy E. Sestamibi localized parathyroidectomy F. Other parathyroidectomy G. Adrenalectomy (open) H. Adrenalectomy (laparoscopic) I. Thymectomy J. Other major endocrine surgery TOTAL PROCEDURES SECTION XIX 10

11 XX. ORTHOPEDIC (non-trauma) A. Arthroscopy B. Open or closed reduction of fracture C. Repair of tendon or nerve D. Other major orthopedic surgery TOTAL PROCEDURES SECTION XX XXI. NEUROSURGERY A. Craniotomy (non-trauma) B. Extracranial/ventricular shunt placement C. Spinal cord/nerve root decompression D. Peripheral nerve decompression E. ICP or ventriculostomy (non-trauma) F. Laminectomy G. Cervical discectomy H. Other major neurosurgery TOTAL PROCEDURES SECTION XXI Procedures Mortalities XXII. TRAUMA A. Exploratory laparotomy for trauma B. Exploratory laparoscopy for trauma C. Neck trauma exploration only D. Esophageal trauma repair/resection/exclusion E. Gastric trauma repair/resection/exclusion F. Duodenal trauma repair/resection/exclusion G. Hepatic trauma repair/pack of laceration H. Hepatic resection for trauma I. Splenectomy/splenorrhaphy for trauma J. Pancreatic trauma repair/resection/drainage K. Small bowel trauma repair/resection/exclusion L. Colorectal trauma repair/resection/exclusion M. Kidney trauma repair/resection/exploration N. Ureteral trauma repair/resection O. Bladder trauma repair/resection P. Diaphragm trauma repair Q. Thoracic trauma open exploratory thoracotomy R. Thoracic trauma thorascopic (VATS) S. Bronchial trauma repair T. E.D. thoracotomy with pericardotomy U. Cardiac trauma repair V. Pericardial window with drainage W. Aorta and great vessel trauma repair X. Carotid artery/neck vessel trauma repair Y. Vena cava trauma repair Z. Peripheral artery or vein trauma exploration/repair AA. Closed reduction of fracture (trauma) 11

12 BB. Open reduction of fracture (trauma) CC. Craniotomy (trauma) DD. Placement of ICP or ventriculostomy (trauma) EE. Reduction of maxillofacial fracture (trauma) FF. Debridement of major traumatic wounds GG. Fasciotomy of extremity for trauma HH. Burn debridement and/or grafting II. Escharotomy for major burn JJ. Other major trauma surgery TOTAL PROCEDURES SECTION XXII XXIII. PEDIATRIC A. Inguinal hernia (unilateral pediatric) B. Inguinal hernia (bilateral pediatric) C. Umbilical hernia (pediatric) D. Pyloromyotomy (pediatric) E. Orchiopexy (pediatric) F. Hydrocelectomy (pediatric) Procedures Mortalities G. Diaphragmatic hernia repair (pediatric) H. Repair branchial cleft/thyroglossal duct cyst I. Chest wall deformity J. Omphalocele/gastroschisis K. Procedure for meconium ileus/nec L. Procedure for Hirshsprung s M. Procedure for intestinal atresia/stenosis N. Procedure for imperforate anus O. Procedure for malrotation/intussusception P. Procedure for esophageal atresia and TE fistula Q. Resection of pediatric tumor R. Arterial cannulation for ECMO S. Epi/hypo-spadias T. Other major pediatric surgery TOTAL PROCEDURES SECTION XXIII XXIV. UROLOGY A. Operations On Kidney 1. Nephrostomy 2. Nephrolithotomy 3. Extracorporeal renal lithotripsy 4. Drainage of perinephric abscess 5. Partial nephrectomy (non-trauma) 6. Total nephrectomy (non-trauma) 7. Other major kidney surgery 12

13 B. Operations on Ureter 1. Ureterolithotomy 2. Ileal conduit construction 3. Other external diversion 4. Other anastomosis 5. Repair of ureter (non-trauma) 6. Other major ureter surgery C. Operations on Urinary Bladder 1. Cystostomy 2. Partial cystectomy 3. Total cystectomy 4. Repair of bladder (non-trauma) 5. Other major bladder surgery 6. Open bladder suspension 7. Laparoscopic bladder suspension 8. Other repair for incontinence 9. Other major urinary bladder surgery D. Operations on Prostate 1. Prostatectomy 2. Transurethral prostatectomy (TURP) 3. Radical prostatectomy Procedures Mortalities 4. Other major prostate surgery E. Operations on Testis/Penis 1. Unilateral orchiectomy 2. Bilateral orchiectomy 3. Orchiopexy (non-pediatric) 4. Hydrocelectomy (non-pediatric) 5. Vasectomy (during hernia repair) 6. Vasovasostomy 7. Insertion / removal of penile implant 8. Other major testis or penis surgery XXV. GYNECOLOGY TOTAL PROCEDURES SECTION XXIV A. Operations on Ovary 1. Wedge resection ovary 2. Oophorectomy 3. Unilateral salpingo-oophorectomy 4. Bilateral salpingo-oophorectomy 5. Repair of ovary 6. Aspiration/fulgarization ovarian cyst 7. Laparoscopic oophorectomy 8. Laparoscopic salphingo-oophorectomy 9. Laparoscopic aspiration ovarian cyst 10. Other major ovary surgery 13

14 B. Operations on Fallopian Tube 1. Unilateral salpingectomy 2. Bilateral salpingectomy 3. Ligation and division fallopian tube (open) 4. Ligation and division fallopian tube (laparoscopic) 5. Salpingoplasty 6. Laparoscopic Salpingectomy 7. Other major fallopian tube surgery C. Operations On Uterus 1. Total abdominal hysterectomy a. With salpingo-oophorectomy b. Without salpingo-oophorectomy 2. Vaginal hysterectomy 3. Laparoscopic assisted vaginal hysterectomy (LAVH) 4. Anterior/posterior pelvic exenteration 5. Other major uterus surgery D. Operations On Vagina 1. Obliteration or total excision of vagina 2. Vaginal reconstruction 3. Cystocele repair (anterior colporrhaphy) 4. Rectocele repair (posterior colporrhaphy) Procedures Mortalities 5. Cystocele with rectocele repair 6. Enterocele repair 7. Other major vagina surgery TOTAL PROCEUDRES SECTION XXV XXVI. ORGAN TRANSPLANT A. Liver transplant B. Renal transplant C. Pancreas transplant D. Renal-pancreas transplant E. Donor nephrectomy F. Donor hepatectomy G. En bloc abdominal organ retrieval H. Other major organ transplant TOTAL PROCEDURES SECTION XXVI 14

15 XXVII. ENCOSCOPY a. Esophagogastroduodenoscopy (EGD) b. Percutaneous endoscopic gastrostomy (PEG) c. Colonoscopy d. Bronchoscopy e. Rigid sigmoidoscopy f. Flexible sigmoidoscopy g. Cystoscopy h. Mediastinoscopy i. ERCP j. Other major endoscopy TOTAL PROCEDURES SECTION XXVII 15

16 GENERAL SURGERY DEPARTMENTAL SEGREGATED TOTALS PART II MINOR PROCEDURES Institution: Total General Surgery Minor Procedures for Training Year: Procedures Mortalities I. WOUNDS/LACERATIONS A. Opening abdomen B. Closing abdomen C. Excision of benign skin lesions D. Repair of simple laceration E. Repair of complex laceration F. Debridement of ulcer/wound G. Drainage of abscess H. Excision of lymph node I. Other minor wound surgery TOTAL PROCEDURES SECTION I II. HEMORRHOIDECTOMY A. Surgical excision B. Harmonic scalpel C. Rubber band ligation D. Injection therapy E. Other hemorrhoidectomy TOTAL PROCEDURES SECTION II III. ANUS A. Fissurectomy B. Fistulectomy C. Drainage of perianal abscess D. Other minor anus surgery TOTAL PROCEDURES SECTION III 16

17 Procedures Mortalities IV. BREAST A. Excision of palpable mass B. Excision of nonpalpable mass (needle-localization) C. ABBI D. Mammotome E. Drainage of breast abscess F. Aspiration of breast cyst G. True-cut breast biopsy H. Other minor breast surgery/biopsy TOTAL PROCEDURES SECTION IV V. GYNECOLOGY A. Excision of vulva lesion B. Drainage/excision Bartholin cyst C. Repair of vagina laceration D. Excision of vagina lesion E. Colposcopy F. Cervical conization G. Repair of cervical laceration H. Fractional dilatation and curettage (D&C) I. Endometrial biopsy J. Other minor gynecological surgery TOTAL PROCEDURES SECTION V VI. GENITOURINARY A. Urethral dilatation B. Cystoscopy C. Circumcision (pediatric/adult) D. Vasectomy E. Supra-pubic catheter placement F. Other minor genitourinary surgery TOTAL PROCEDURES SECTION VI VII. VASCULAR ACCESS PROCEDURES A. Temporary dialysis catheter placement B. Permanent dialysis catheter placement C. Infusaport (Mediport) catheter placement D. Hickman/Groshong catheter placement E. Broviac (pediatric) venous catheter placement F. Removal of permanent vascular access device G. Other vascular access procedure TOTAL PROCEDURES SECTION VII 17

18 Procedures Mortalities VIII. SURGICAL NUTRITION A. Needle jejunostomy placement B. Nasojejunal feeding tube placement C. Total parenteral nutrition (TPN) management D. Other surgical nutrition procedure/management TOTAL PROCEDURES SECTION VIII IX. SURGICAL CRITICAL CARE A. Central venous catheter placement B. Arterial line placement C. Pulmonary artery catheter placement (Swan-G anz) D. Hemodynamic parameter management E. Ventilator management (routine) F. Ventilator management (complex) G. Oral/nasal endotracheal intubation H. ACLS code I. Open tracheostomy J. Percutaneous tracheostomy K. ICP/CPP management L. RVEDVI catheter placement M. Chest tube placement (non-trauma) N. Abdominal compartment pressure monitoring O. Trans-venous pacemaker placement P. Gastric tonometry management Q. CVVH/CAVH R. PICC line placement S. Other critical care procedure TOTAL PROCEDURES SECTION IX X. TRAUMA PROCEDURES A. ATLS/FAST B. FAST (repeat examination) C. Chest tube placement D. Introducer (Cordis) placement E. Emergent cricothyroidotomy F. Diagnostic peritoneal lavage (DPL) G. Pericardiocentesis H. Saphrenous vein cut-down I. Other minor trauma procedure TOTAL PROCEDURES SECTION X 18

19 Procedures Mortalities XI. MISCELLANEOUS PROCEDURES A. Paracentesis B. Thoracentesis C. Needle liver biopsy D. Needle aspiration thyroid cyst E. Other minor surgical procedure (list separately) TOTAL PROCEDURES SECTION XI Comments: 19

Summary of Operative Experience

Summary of Operative Experience (Remarks: Programme Directors of respective Specialty Boards will conduct random check of the trainee s Logbook Summary and Logbook Summary Report against the operation