National Vascular Registry AAA Repair Patient Details Patient Consent* 0 No 2 Not Required If patient not consented: Date consent recorded / / (DD/MM/YYYY) Do not record NHS number, NHS number* name(s) or postcode. Date of birth* / / (DD/MM/YYYY) If consent not required: Sex* 1 Male 2 Female Ignore consent date. Last name First name Postcode* Admission Details Admission date* / / (DD/MM/YYYY) Mode of admission* 1 Elective 2 Non-elective Hospital code* Local ID* Procedure type Pre-populated drop down menu on NVR audit site Abdominal Aortic Aneurysm Repair Pre-operative: Pathway Elective Indication for intervention 0 5.5 screen detected aneurysm (NAAASP) 1 5.5 screen detected aneurysm (non NAAASP) 2 5.5 lesion non-screen detected aneurysm 3 Symptomatic 4 Rapid growth 5 Other threshold Non-elective Prior contact 0 Not known, on surveillance 2 Yes, not for elective repair 3 Yes, on waiting list or booked for surgery continued on next page * Mandatory fields Date of release 26/01/2016 AAA Repair: 1 of 6
AAA Threshold CT/MR angio assessment date MDT discussion date / / (DD/MM/YYYY) / / (DD/MM/YYYY) / / (DD/MM/YYYY) continued from previous page Anaesthetic Assessment (for Elective Pathway only) Date of Anaesthetic review / / (DD/MM/YYYY) Consultant vasc anaesthetist review 0 No Fitness measurement used* 0 None 1 CPET 2 Incremental shuttle walk test 3 6 Minute walk test 4 Dynamic test of cardiac function 5 Echo +/- pulmonary function tests Investigation after preop anaesthetic assessment* 1 No additional investigation /intervention 2 Referral to another specialty 3 Further investigations required 4 Optimization in drug therapy For both Elective and Non-elective pathways Patient weight* Patient height* in Kg in cm * Mandatory fields Date of release 26/01/2016 AAA Repair: 2 of 6
Indications AAA/Aortic Diameter* in mm Previous Aortic op* 0 No 1 Open repair 2 Endovascular repair 3 AAA repair type unknown 4 Both open and endovascular repair Risk Scoring Comorbidities* Please select as many options as applicable. 0 None 1 Diabetes 2 Hypertension 3 Chronic lung disease 4 Ischaemic heart disease 5 Chronic heart failure 6 Chronic renal disease 7 Stroke Smoking status* 1 Current or stopped 2 Ex-smoker 3 Never smoked within 2 months White cell count* Sodium* Potassium* Creatinine* Albumin Haemoglobin* (x10 9 /l) (mmol/l) (mmol/l) (µmol/l) (g/l) (g/dl) Abnormal ECG* 0 Normal 1 Abnormal ASA Grade* 1 1 Normal 2 2 Mild disease 3 3 Severe, not life-threatening 4 4 Severe, life-threatening 5 5 Moribund patient Pre-operative 0 None 4 ACE inhibitor / ARB medication* 1 Anti-platelet 5 Antibiotic prophylaxis 2 Statin 6 DVT prophylaxis 3 Beta blocker * Mandatory fields Date of release 26/01/2016 AAA Repair: 3 of 6
Procedure: AAA Repair Date/Time start / / (DD/MM/YYYY); : (HH:MM) Aortic status* 1 Asymptomatic 4 Aortic transection 2 Symptomatic unruptured 3 Ruptured 5 Acute dissection 6 Chronic dissection Type of repair* 1 Open 4 Revision Open 2 EVAR 5 Revision EVAR (See relevant sections below) 3 Complex EVAR 6 EVAS (See relevant sections below) OPCS code of procedure 1* All options will be available on NVR OPCS code of procedure 2 audit site via drop down menus. OPCS code of procedure 3 Open AAA Clamp site 1 Infra-renal AAA Graft 1 Tube 2 Supra-renal 3 Supra-mesenteric 4 Supra-coeliac 5 Thoracic aorta 2 Bifurcate iliac 3 Bifurcate groin 4 Uni-iliac and crossover EVAR & EVAS Complex EVAR Additional items EVAR exclusion* Neck angle 0 No primarily 2 Yes after adjunctive procedures 1 0 to 60 degrees 2 60 to 75 degrees 3 75 to 90 degrees 4 More than 90 degrees Type of 1 FEVAR complex 2 BEVAR EVAR 3 TEVAR 4 Iliac branched graft 5 Composite graft 6 Chimney/periscope/snorkel Iliac branch 0 No 1 Right 2 Left 3 Bilateral Neck diameter Neck length in mm in mm continued on next page Note: If complex EVAR is 3=TEVAR, then the following questions won t appear on the screen: iliac branch, neck angle, neck length, extended into external iliac artery, common iliac artery diameter * Mandatory fields Date of release 26/01/2016 AAA Repair: 4 of 6
Extended External 0 No 1 Right Iliac Artery (EIA) 2 Left 3 Bilateral Common Iliac Artery (CIA) diameter in mm EVAS Additional items Type of EVAS device 1 Standard 2 Chimney/periscope/snorkel Endoleak Endoleak type* continued from previous page 0 No endoleak 1 Type 1 2 Type 2 3 Type 3 4 Type 4 5 Unclassified If NO endoleak ignore the next 2 items. Endoleak intervention 0 No Success 0 No Operator Vascular specialist 1* Anaesthetist 1* Vascular specialist 2 Anaesthetist 2 Vascular specialist 3 Vascular specialist 4 Peri-operative Anaesthetic Details Anaesthetic type* 1 Local anaesthetic 4 GA plus regional anaesthetic 2 Regional anaesthetic 3 General anaesthetic 5 GA plus peripheral nerve blockade 6 Regional plus peripheral nerve blockade Direct arterial monitoring 0 No Intraoperative cardiac output monitoring 0 No Postoperative coagulopathy 0 No Core temperature 36 o C at end of procedure 0 No Patient reported severe pain within 1 hour of surgery 0 No Postoperative vomiting within 3 hours of surgery 0 No Post Operative Destination after surgery* 1 Ward 2 Level 2 (HDU/PACU) 4 Level 3 (ICU) 5 Died in theatre Note: If Died in theatre is selected, the remaining questions in the post-operative section will not show * Mandatory fields Date of release 26/01/2016 AAA Repair: 5 of 6
Critical care stay* (Number of days) Return to theatre within admission* 0 No Readmission to a higher level of care* 0 No Postoperative complications* Please select as many options as applicable. 0 None 1 Cardiac (MI / NSTEMI / heart failure) 2 Respiratory 3 Cerebral (stroke) 4 Renal failure 5 Haemorrhage 6 Limb ischaemia 7 Paraplegia 8 Bowel ischaemia Discharge Discharge status Alive on discharge* 0 No Date discharged/died* / / (DD/MM/YYYY) Anaesthetic Details All items shown in this screen are pre-populated from the information you have recorded in the following sections: Anaesthetic Assessment (Page2) Peri-operative Anaesthetic Details (Page 5) Follow Up Readmission to hospital within 30 days 0 No Reason for NO follow up Date clinic appointment attended 1 Died prior to planned follow-up after discharge 2 Moved out of area 3 Did not attend 4 Other / / (DD/MM/YYYY) (Only if follow up occurred) If you have any queries please contact us on 020 7869 6621 and nvr@rcseng.ac.uk * Mandatory fields Date of release 26/01/2016 AAA Repair: 6 of 6