Standardized Operative Report
The use of checklists for complicated processes is widely embraced and leads to reductions in morbidity as well as mortality rates of hospitalized patients.[1] Checklists help avoid omission of crucial steps, especially during uncommonly performed procedures or when information complexity negatively impacts situational awareness.[2]
The Quality Assessment and Safety Committee of the American Society of Colon and Rectal Surgeons (ASCRS) developed a rectal cancer surgery checklist as a guide to enhance safety and quality of care for patients with rectal cancer undergoing surgery, to incorporate best practices in treating these patients, to raise general awareness of the importance of each individual checklist item, and to serve as a potential foundation for building accredited centers in rectal cancer treatment.[3] The OSTRiCh (Optimizing the Surgical Treatment of Rectal Cancer) Standardized Synoptic Operative Report Committee subsequently utilized the ASCRS rectal cancer checklist as a guide in the development of its standardized synoptic operative report (Table 1). The National Accreditation Program for Rectal Cancer (NAPRC), developed through collaboration between The OSTRiCh Consortium and the American College of Surgeons Commission on Cancer (CoC), now includes synoptic operative reporting as a standard for Rectal Cancer Program NAPRC accreditation.[4]
The use of synoptic operative reporting in rectal cancer has been shown to increase the completeness and reliability of documentation of critical elements when compared to narrative reporting.[5],[6]
Reprinted with the permission of the OSTRiCh Standardized Synoptic Operative Report Committee. | |
Elements | Response Options |
1. ASA score | I; II; III; IV; V |
2. Case status | Elective; urgent (obstructed; bleeding; perforated) |
3. Operation | LAR; APR; TPC; local excision |
4. Modality | Open; laparoscopic; hand-assisted laparoscopic; robotic; TES |
5. Location of tumor within rectum | High; middle; low |
6. Height of lower edge of tumor from anal verge | 0–20 cm |
7. Mobilization of splenic flexure | Yes; no |
8. Level of ligation of inferior mesenteric artery | IMA; SRA; none |
9. Level of ligation of inferior mesenteric vein | High; low; none |
10. Level of rectal transection distal to distal edge of tumor (distal margin) | 0–20 cm |
11. Type of reconstruction | Stapled end-end; stapled end-side; handsewn end-end; handsewn end-side; colon J-pouch; ileal pouch-anal anastomosis; coloplasty; none |
12. Anastomotic testing method(s) | Rectal air infusion under pelvic fluid; rectal instillation of betadine, indigo, or other fluid; palpation; observation of circular stapler rings only; none |
13. Creation of stoma | Yes (ileostomy; colostomy); no |
14. En bloc resection | Yes (bladder; vagina; prostate; ureter; small intestine; sacrum; other); no |
15. Metastectomy | Yes (liver; peritoneum; other); no |
16. Completeness of tumor resection | R0; R1; R2 |
17. Intraoperative complications | Yes (ureter injury; rectal perforation; enterotomy; vascular injury; other); no |
18. Blood transfusion | Yes; no |
19. TME photographed | Yes—in pathology report; yes—in operative report; no |
20. Short narrative | *** |
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