An audit on the documentation of the interpretation of chest radiographs following thoracic surgery
Authors: Daron Nazari, Kapil Sugand, Martin Yates, Ian Hunt
Journal: International Journal of Surgery (2013)

s / International Journal of Surgery 11 (2013) 589e685 614 ABSTRACTS Conclusions: Whilst discharge documentation has improved, significant deviation from local guidelines remains and is principally due to use of antiplatelet therapy after mitral repair. 0941: AN AUDIT ON THE DOCUMENTATION OF THE INTERPRETATION OF CHEST RADIOGRAPHS FOLLOWING THORACIC SURGERY Daron Nazari , Kapil Sugand , Martin Yates , Ian Hunt . 1 St George's University of London, London, UK; 2 Imperial College London, London, UK. Aims: All patients undergoing thoracic surgery at our institution undergo post-operative and post-drain removal chest radiographs (CXR). General Medical Council (GMC) Good Medical Practice guidelines state that the interpretation of all investigations should be documented by the requesting physician. The aim of this audit was to assess compliance with GMC standards. Methods: A prospective audit was carried out of all patients who underwent thoracic surgery between 1st November and 7th December 2012. Quality of documentation within the patient record was assessed by a single investigator for both the post-operative and the post-drain removal CXR's. For each CXR, basic demographics (date, patient details and physician identification) and the presence or absence of post-operative pulmonary complications were assessed. Results: During the period of study 63 patients underwent thoracic surgery. 49(78%) patients had documentation of post-operative and 46(73%) post-drain removal CXRs. However, more detailed clinical information was included in only 9(14%) and 12(19%) of records respectively. Conclusions: There is a suboptimal level of documentation of routine CXRs post-thoracic surgery. Improvement, therefore, is crucial in recording the presence or absence of radiographic post-operative complications in patient records. A pro forma for CXR documentation has been introduced and re-audit is currently in progress. 0982: THE EUROSCORE II IS A BETTER PREDICTOR OF MORTALITY THAN LOGISTIC EUROSCORE FOR PATIENTS UNDERGOING TRANSCATHETER AORTIC VALVE IMPLANTATION Ashok Kar, Daniel Moffat, Simon Kennon, Anne Malecki, Wael Awad. London Chest Hospital, London, UK. Objectives: Patient selection for transcatheter aortic valve implantation (TAVI) is critical because of proven efficacy for conventional aortic valve surgery (AVR). Currently available risk scoring systems are known to be inadequate; logistic Euroscore (LES) over predicts mortality for AVR. This study compared predictive ability of the new EuroSCORE II (ES2) with LES in patients undergoing TAVI. Methods: All patients undergoing TAVI (January 2009 September 2012) were identified from our registers. LES and ES2 scores were calculated and predicted mortalities for the 2 scoring systems compared with that observed. Results: 124 patients underwent TAVI: 3 cases were excluded due to insufficient data. Mean age of patients (n1⁄4121) was 81.9 years (75 e 91). Mean predicted LES was 21.6 12.6 compared to 7.7 6.2 for ES2; paired student t-test showed ES2 to be significantly lower (p   60kg. This may contribute to longer hospital admissions and more patients being discharged in AF. Other cardiac units should be encouraged to audit local practice and initiate change to guidelines. 1225: PRE-OPERATIVE TOPICAL ANTISEPTICS AND POST-OPERATIVE INFECTION RATES IN CARDIOTHORACIC SURGERY: META-ANALYSES OF PROSPECTIVE STUDIES Sudeep Das De. University of Cambridge, Cambridge, UK. Aim: To investigate the role of routine pre-operative topical antiseptic agents in cardiothoracic surgery. Background: Staphylococcus aureus is a major cause of post-operative infection after open-heart surgery, with the patient's endogenous flora as the principal source. However the routine use of pre-operative topical antiseptics in all cardiothoracic patients has not been established. In a meta-analysis, we quantitatively assessed the associations reported in prospective studies of routine use of preoperative topical antiseptics. Methods and Results: Studies were identified by computer-assisted searches of the published literature and scanning of relevant reference lists. The following was abstracted: size and type of cohort, mean age, mean duration of follow-up, and the relative risk ratio of developing a post-operative infection when using topical antiseptic agents. There were 5 studies reporting the use of pre-operative chlorhexidine and 4 studies on topical mupirocin. The combined relative risk ratio of developing a postoperative infection when using topical chlorhexidine versus the control armwas 0.47 (CI 0.39-0.63, p<0.05). The combined relative risk ratio when using topical mupirocin of developing an infection was 0.43 (CI 0.32-0.72, p<0.05). Conclusion: Published prospective studies provide good evidence to support the routine use of preoperative topical antiseptic agents.