Domain | Number of items | Quality indicator* | Round included |
---|---|---|---|
Team demographics | 11 | Procedure date | 2 |
Report date | 2 | ||
Reported by | 2 | ||
Additional physicians to receive operative report | 2 | ||
Procedure planned | 2 | ||
Procedure performed | 2 | ||
Surgeon | 2 | ||
Assistant(s) | 2 | ||
Level of training of primary operator | 2 | ||
Anesthetic | 2 | ||
Hospital or site of procedure | 2 | ||
Patient demographics | 10 | Preoperative diagnosis | 2 |
Postoperative diagnosis | 2 | ||
Name | 2 | ||
Date of birth | 2 | ||
Age | 2 | ||
Sex | 2 | ||
Medical record number/health number | 2 | ||
Preoperative BMI (kg/m2) | 3 | ||
Previous relevant surgeries | 3 | ||
Past cancer history | 3 | ||
Preoperative workup and preparation | 12 | Bowel preparation | 2 |
Antibiotics in bowel preparation | 2 | ||
Preoperative imaging modality | 2 | ||
Lesion characteristics on imaging | 2 | ||
Preoperative biopsy performed (y/n) | 2 | ||
Pathology results | 2 | ||
Pathology high-risk features | 2 | ||
If lesion is cancer, preoperative staging evaluation | 2 | ||
If lesion is cancer, preoperative TNM stage | 2 | ||
Preoperative endoscopic assessment/findings | 2 | ||
Endoscopy extent | 3 | ||
Prior treatments | 2 | ||
Lesion characteristics | 9 | Fixed or mobile | 2 |
Distance from dentate line (cm) | 2 | ||
Distance from anal verge (cm) | 2 | ||
Relation to rectal folds | 2 | ||
Extent into anal canal (y/n) | 2 | ||
Size (cm) | 2 | ||
Percent circumference | 2 | ||
Appearance | 2 | ||
Location/orientation (anterior, posterior, left, right) | 2 | ||
Intraoperative procedure details | 20 | Intent of procedure (cure, palliation) | 2 |
Patient position | 2 | ||
Platform (TAMIS, TEM) | 2 | ||
Preoperative antibiotics | 2 | ||
DVT prophylaxis | 2 | ||
Skin preparation | 3 | ||
Time-out performed (y/n) | 2 | ||
Lifting with saline or epinephrine | 2 | ||
Defect closure (y/n) | 2 | ||
If defect closed, technique and material used | 2 | ||
Intraperitoneal entry (y/n) | 2 | ||
Completeness of excision | 2 | ||
Closest gross mucosal margin | 2 | ||
How the margins of the specimen are marked | 3 | ||
Piecemeal excision (y/n) | 2 | ||
Unexpected findings or events | 2 | ||
Additional procedures performed | 2 | ||
Complications | 2 | ||
Plane of dissection | 2 | ||
Need for laparoscopy or laparotomy and reasons | 2 | ||
Postoperative details and plan | 5 | Estimated blood loss (mL) | 2 |
Discharge plan | 2 | ||
Reasons if not day surgery | 2 | ||
Postoperative condition | 2 | ||
Additional information/notes (free text) | 2 |
BMI = body mass index; DVT = deep vein thrombosis; TAMIS = transanal minimally invasive surgery; TES = transanal endoscopic surgery; TNM = tumour, node, metastasis stage according to American Joint Committee on Cancer.
↵* Bold text indicates surgeon input data.
Remaining fields can be pre-populated from electronic chart.