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The Computer Synoptic Operative Report—A Leap Forward in the Science of Surgery

From the Institute of Oncology Ljubljana (IE), Ljubljana, Slovenia; University of Calgary/Tom Baker Cancer Centre (WJT), Calgary, Alberta, Canada; Cross Cancer Institute (CJdeG), Edmonton, Alberta, Canada; and Faculty of Medicine (GCES), University of British Columbia, Vancouver, British Columbia, Canada.

ABSTRACT

Background: Quality of surgery is a proven prognostic factor in many tumors. It is critical to ensure that an effective method is in place to evaluate surgery accurately.

Material and Methods: A provincial Cancer Surgery Working Group designed and piloted a computerized synoptic operative report template (WebSMR) in rectal cancer surgery, to replace the standard narrative operative record (NR). This included a precise description of the procedure, data on demographics, diagnostic evaluation, staging, and functional measures. A total of 70 items for anterior resection (AR) and 63 items for abdominoperinal excision (APR) were included. The WebSMR was assessed for comparison with 40 NR randomly selected from seven hospitals in Southern Alberta from 2001 to 2003.

Results: The NR contained 45.9% of the specified data elements and the WebSMR captured 99%. The most complete NR data (68.8% to 97%) concerned hospital and patient data, anesthetist and surgeon information, approach, and closure details. The important details of laparotomy and tumor resection were the next most complete data (33.5% to 47.5%) and the least complete (0 to 25%) concerned preoperative treatment, comorbidity, and metastatic and local assessment. All differences among these groups were statistically different (P < .001). No statistically significant differences were seen in the completeness of the NR according to the type of surgery (AR vs. APR; P = .1) or the dictating surgeon (colorectal vs. general vs. resident; P = .175). The time needed to complete the WebSMR test was only 6 minutes.

Conclusion: The science of surgical technique can be better measured by this unique instrument and will create accountability in surgery.

Key Words: Rectal cancer • Quality control • Computer • Operative report • Surgery • Synoptic • Narrative