Post-Procedure Complications Monitoring Programme 44th Review Meeting Friday, 22 August 2014 4:00 - 6:00pm, 4/F, Arthur K C Li Surgical Library Lui Che Woo Clinical Sciences Building, PWH

Attendance Present Prof. Paul B S Lai (Chairman) Team 1 – Dr. Sunny Cheung & Dr. Ray Hung Team 2 – Dr. Simon K H Wong & Dr. H C Yip Team 3 – Dr. Hon Sok Fei & Dr. Eric Y F Cheung Team 4 – Dr. Micah C K Chan NS – Dr. W K Mak & Dr. Emily K Y Chan PSU – Dr. Peter Y H Tam URO – Dr. Samuel C H Yee CTS – Prof. Calvin Ng & Dr. Micky Kwok Mr. Alfred Chan Ms. Daisy Feng Ms. Eunice Tam

Items discussed Complications report – June 2014 AOB

1. Complications Report – June 2014

June 2014 Summary (case collection progress and Complication rate) PRS NS PSUR URO CTS Dept. total Total cases 58 72 31 52 47 44 57 59 478 Missing cases 1 3 4 Non-Discharged * 2 12 Complication rate and Magnitude Team 1 Team 2 Team 3 Team 4 PRAS NS PSUR URO CTS Total No. of Complication 11 3 4 2 9 5 56 58 72 31 52 47 44 57 59 478 Complication Rate 18.97% 15.28% 8.62% 12.90% 3.85% 19.15% 11.36% 3.51% 15.25% 11.72%

Team 1 – Hepato-biliary and Pancreatic Surgery

Team 1 – Hepato-biliary and Pancreatic Surgery ( Cont’d 2/10)

Team 1 – Hepato-biliary and Pancreatic Surgery ( Cont’d 3/10)

Team 1 – Hepato-biliary and Pancreatic Surgery ( Cont’d 4/10) Culture negative Rare to have same pathology at the same time

Pneumonia (pseudomonas) Team 1 – Hepato-biliary and Pancreatic Surgery ( Cont’d 5/10) Surgical strategy needed to be reviewed for this type of case Need to be proactive in pain control Pneumonia (pseudomonas)

Required re-operation (case 7) Team 1 – Hepato-biliary and Pancreatic Surgery ( Cont’d 6/10) Required re-operation (case 7) Same patient

Team 1 – Hepato-biliary and Pancreatic Surgery ( Cont’d 7/10) Dr. Ray Hung : Review the preparation for patients with anti-coagulants before GS procedure For discussion at Team 1 Meeting M & M

Team 1 – Hepato-biliary and Pancreatic Surgery ( Cont’d 8/10) Pathology : perforated adeno-carcinoma M & M GI leakage

Team 1 – Hepato-biliary and Pancreatic Surgery ( Cont’d 9/10)

Team 1 – Hepato-biliary and Pancreatic Surgery ( Cont’d 10/10)

Team 2 – Upper Gastro-intestinal Surgery

Team 2 – Upper Gastro-intestinal Surgery ( Cont’d 2/9)

Team 2 – Upper Gastro-intestinal Surgery ( Cont’d 3/9) Dr. H C Yip to feedback to Dr. Anthony Fong putting up a drain is not a replacement of proper lavage Pelvic a abscess collection

Team 2 – Upper Gastro-intestinal Surgery ( Cont’d 4/9)

Team 2 – Upper Gastro-intestinal Surgery ( Cont’d 5/9) Feedback to surgeon Patient woke up & aspirate Why retrograde decompression M & M Very Long (4 hours 20 mins)

Team 2 – Upper Gastro-intestinal Surgery ( Cont’d 6/9) anastomotic leakage (rare complication for small bowel) Same patient

Team 2 – Upper Gastro-intestinal Surgery ( Cont’d 7/9) appropriateness of endoscopy setting case selection for doing in endoscopy centre Why not lap repair ?

Team 2 – Upper Gastro-intestinal Surgery ( Cont’d 8/9)

Team 2 – Upper Gastro-intestinal Surgery ( Cont’d 9/9)

Team 3 – Colorectal Surgery

Team 3 – Colorectal Surgery ( Cont’d 2/6)

Team 3 – Colorectal Surgery ( Cont’d 3/6)

Team 3 – Colorectal Surgery (Cont’d 4/6) ( Cont’d 4/6)

Team 3 – Colorectal Surgery ( Cont’d 5/6)

Team 3 – Colorectal Surgery ( Cont’d 6/6) Open & Closed

Team 4 – Vascular Surgery

Team 4 – Vascular Surgery ( Cont’d 2/6)

Team 4 – Vascular Surgery ( Cont’d 3/6) Care from AHNH (Index OT done in May 2014) and discussed - Should not have used the ‘glue’ (feedback to radiologist already)

Team 4 – Vascular Surgery ( Cont’d 4/6) Same patient

Team 4 – Vascular Surgery ( Cont’d 5/6)

Team 4 – Vascular Surgery ( Cont’d 6/6)

Plastic, Reconstructive and Aesthetic Surgery

Plastic, Reconstructive and Aesthetic Surgery ( Cont’d 2/4)

Plastic, Reconstructive and Aesthetic Surgery ( Cont’d 3/4)

Plastic, Reconstructive and Aesthetic Surgery ( Cont’d 4/4)

Neurosurgery * Observed a surge in wound infection

Neurosurgery ( Cont’d 2/8)

Neurosurgery ( Cont’d 3/8)

Neurosurgery ( Cont’d 4/8)

Neurosurgery ( Cont’d 5/8) Culture negative Rare

Neurosurgery ( Cont’d 6/8) No mention of post-mortem

Neurosurgery ( Cont’d 7/8)

Neurosurgery ( Cont’d 8/8)

Paediatric Surgery & Paediatric Urology

Paediatric Surgery & Paediatric Urology ( Cont’d 2/6)

Paediatric Surgery & Paediatric Urology ( Cont’d 3/6) 2 Re-implantation will be difficult

Paediatric Surgery & Paediatric Urology ( Cont’d 4/6) 1 2 Post-rep ilea's because of require TPN

Paediatric Surgery & Paediatric Urology ( Cont’d 5/6) worthwhile to track adolescent herncorigly

Paediatric Surgery & Paediatric Urology ( Cont’d 6/6)

Urology

Urology ( Cont’d 2/4)

Urology ( Cont’d 3/4)

Urology ( Cont’d 4/4)

Cardiothoracic Surgery

Cardiothoracic Surgery ( Cont’d 2/9)

Cardiothoracic Surgery ( Cont’d 3/9) + cord palsy known complication Same patient Not counted

Cardiothoracic Surgery ( Cont’d 4/9)

Cardiothoracic Surgery ( Cont’d 5/9)

Cardiothoracic Surgery ( Cont’d 6/9) Should look at the practice of using empirical antibiotics (which is not yet evidence – based)

Cardiothoracic Surgery ( Cont’d 7/9) Challenging case because of redo Bentall still in ICU

Cardiothoracic Surgery ( Cont’d 8/9)

Cardiothoracic Surgery ( Cont’d 9/9)

2. AOB

AOB Nil

THE END