Post-Procedure Complications Monitoring Programme 45th Review Meeting Friday, 19 September 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 (Chair the 2nd half of meeting) Team 3 – Dr. Hon Sok Fei & Dr. Eric Y F Cheung Team 4 – Dr. Micah C K Chan PRAS – Dr. Teresa Tan NS – Dr. Emily K Y Chan PSU – Dr. Edwin K W Chan & Dr. Vicky H Y Wong URO – Dr. C K Chan CTS – Prof. Calvin Ng Mr. Alfred Chan Ms. Daisy Feng Mr. Philip Yeung Ms. Eunice Tam

Items discussed Complications report – July 2014 AOB

1. Complications Report – July 2014

July 2014 Summary (case collection progress and Complication rate) PRS NS PSUR URO CTS Dept. total Total cases 69 57 75 44 51 45 81 64 537 Missing cases Non-Discharged * 1 6 2 12 Complication rate and Magnitude Team 1 Team 2 Team 3 Team 4 PRAS NS PSUR URO CTS Total No. of Complication 9 8 6 4 1 2 11 53 69 57 75 44 51 45 81 64 537 Complication Rate 13.04% 14.03% 8.00% 9.09% 1.86% 15.69% 8.89% 2.47% 17.19% 9.87%

Team 1 – Hepato-biliary and Pancreatic Surgery

Team 1 – Hepato-biliary and Pancreatic Surgery ( Cont’d 2/8)

Team 1 – Hepato-biliary and Pancreatic Surgery ( Cont’d 3/8) + GI Leakage + Abdominal collection

Team 1 – Hepato-biliary and Pancreatic Surgery ( Cont’d 4/8) Septum culture : ESBL E Coli + Pancreatic leakage

Dr. Ray Hung to feedback to surgeon Team 1 – Hepato-biliary and Pancreatic Surgery ( Cont’d 5/8) Dr. Ray Hung to feedback to surgeon Add the endoscopic coding

Team 1 – Hepato-biliary and Pancreatic Surgery ( Cont’d 6/8) Index operation Same patient

Team 1 – Hepato-biliary and Pancreatic Surgery ( Cont’d 7/8) Might consider a clamp vs no clamp study

Team 1 – Hepato-biliary and Pancreatic Surgery ( Cont’d 8/8)

Team 2 – Upper Gastro-intestinal Surgery

Team 2 – Upper Gastro-intestinal Surgery ( Cont’d 2/7)

Team 2 – Upper Gastro-intestinal Surgery ( Cont’d 3/7)

Team 2 – Upper Gastro-intestinal Surgery ( Cont’d 4/7)

Team 2 – Upper Gastro-intestinal Surgery ( Cont’d 5/7) Delete case. Not Index operation.

Team 2 – Upper Gastro-intestinal Surgery ( Cont’d 6/7) Resolved quickly

Team 2 – Upper Gastro-intestinal Surgery ( Cont’d 7/7)

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) Confirmed prophylactic antibiotics was given Worth looking at the interval between 1st operation & reversal of ileostomy

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

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

Team 4 – Vascular Surgery

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

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

Patient had renal impairment Team 4 – Vascular Surgery ( Cont’d 4/6) M & M Patient had renal impairment Patient currently stayed in O&T Need to enhance the communication with OT nurses on the preparation and set-up e.g. use of power injector of this kind of emergency

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 2/8)

Plastic, Reconstructive and Aesthetic Surgery ( Cont’d 3/8)

Plastic, Reconstructive and Aesthetic Surgery ( Cont’d 4/8)

Plastic, Reconstructive and Aesthetic Surgery ( Cont’d 5/8)

Plastic, Reconstructive and Aesthetic Surgery ( Cont’d 6/8)

Plastic, Reconstructive and Aesthetic Surgery ( Cont’d 7/8) Nerve palsy Should alert assistant surgeon on this traction injury

Plastic, Reconstructive and Aesthetic Surgery ( Cont’d 8/8)

Neurosurgery

Neurosurgery ( Cont’d 2/8)

Neurosurgery ( Cont’d 3/8)

Neurosurgery ( Cont’d 4/8) Same patient

Neurosurgery ( Cont’d 5/8)

Neurosurgery ( Cont’d 6/8) Same patient

Neurosurgery ( Cont’d 7/8)

Dr. Emily Chan to follow-up on D/C summary Neurosurgery ( Cont’d 8/8) Dr. Emily Chan to follow-up on D/C summary

Paediatric Surgery & Paediatric Urology

Paediatric Surgery & Paediatric Urology ( Cont’d 2/5)

Paediatric Surgery & Paediatric Urology ( Cont’d 3/5) Same patient

Paediatric Surgery & Paediatric Urology ( Cont’d 4/5)

Paediatric Surgery & Paediatric Urology ( Cont’d 5/5)

Urology

Urology ( Cont’d 2/5)

Urology ( Cont’d 3/5)

Urology ( Cont’d 4/5)

Urology ( Cont’d 5/5)

Cardiothoracic Surgery

Cardiothoracic Surgery ( Cont’d 2/12)

Cardiothoracic Surgery ( Cont’d 3/12)

Cardiothoracic Surgery ( Cont’d 4/12)

Cardiothoracic Surgery ( Cont’d 5/12)

Cardiothoracic Surgery ( Cont’d 6/12) Still in HDU 1st operation on 27 Jun 14 + chest infection

Cardiothoracic Surgery ( Cont’d 7/12)

Cardiothoracic Surgery ( Cont’d 8/12) Died in NDH on 17 Sep 14

Cardiothoracic Surgery ( Cont’d 9/12) Died in ICU Not sure what went wrong No positive culture

Cardiothoracic Surgery ( Cont’d 10/12)

Cardiothoracic Surgery ( Cont’d 11/12)

Cardiothoracic Surgery ( Cont’d 12/12)

2. AOB

AOB M & M Cardiac aurest T4 (renal impairment), risk of renal part develop hyperkaekaemia part alert on transfusion.

THE END