Clinical Audit Report:
Determining Surgical Complications in the overweight
(DISCOVER)
(TEMPLATE)
Hospital/Centre:
Supervising Consultant:
Data Collection Team:
Data Collection Period:
How to use this template
1. Reporting back of audit results to key stakeholders including audit departments is
good practice.
2. This may be done in several ways, including presenting your results in an oral
presentation at an audit meeting or departmental meeting. Alternatively your local
audit department may require that you submit a written report of the results.
3. This template is designed to aid you in reporting the results of DISCOVER in
written form to your audit department. Note that your audit department may have
their own template for these reports or may require further information not
covered in this template. In all instances, seek your department’s guidance on
this.
4. All members of the data collection team and the supervising consultant should
approve of the report before submission to audit departments.
5. Feel free to format report and add sections as required.
6. Guidance notes on this template are in red font- delete them before submission.
Page | 1
1.
STARSurg and DISCOVER
Student Audit and Research in Surgery (STARSurg) is a national student-led
collaborative facilitating multi-centre audit and service evaluations. STARSurg is coordinated by a steering group of medical students and surgical trainees. It is represented
locally by a network of medical student and junior doctor collaborators covering all
medical schools in the UK and the Republic of Ireland.
Obesity has reached epidemic levels worldwide. In UK surgical practice, 30% of surgical
patients are obese. There is conflicting evidence on the impact of obesity on postoperative complications after gastrointestinal surgery.
Currently, to ensure patients receive appropriate care, guidelines from the National
Institute for Health and Care Excellence recommend that all patients being admitted into
hospital undergo a calculation of their Body Mass Index (BMI).
DISCOVER aims to audit compliance with NICE guidelines on BMI measurement and
establish whether obesity is associated with an increased risk of post-operative
complications in patients undergoing gastrointestinal surgery
A full protocol including supporting documents detailing the conduct of DISCOVER is
available online for download at http://www.starsurg.org/project/.
2.
(i)
Aims and Objectives of audit
To establish compliance with NICE guidelines requiring early identification of obese
patients.
(ii) To benchmark obese surgical patients’ outcomes against accepted international
standards, determining the role of obesity as a risk factor for major post-operative
complications in current UK and Irish practice.
3.
(ii)
Audit Standards and Criteria
All patients should have body mass index (BMI) calculated on admission to
hospital.
NICE CG 32 1.2.211
NICE CG 32 1.2.611
All hospital inpatients on
admission should be screened
for malnutrition.
Screening should assess body
mass index.
Page | 2
(iii)
Compared to non-obese patients, obese patients should not be at increased
risk of major post-operative complications.
This standard is based on the landmark Lancet study of over six thousand patients by Dindo
et al., which found that the incidence of complications did not differ between obese and nonobese patients4.
4.
Methodology
Summary
Teams supervised by a consultant surgeon, comprising medical students and junior doctors,
prospectively collected data on consecutive patients undergoing gastrointestinal or
hepatobiliary surgery over a 14-day period.
Project Timeline
The overall data collection period was Wednesday 1st October to Wednesday 29th October
2014. The mini-team collected data over two 14-day, consecutive periods.
(DELETE as appropriate)
Period 1: 0800 Wednesday 1st Oct to 0759 Wednesday 15th Oct.
Period 2: 0800 Wednesday 15th Oct to 0759 Wednesday 29th Oct.
Period 3: 0800 Wed 29th Oct to 0759 Wed 12th Nov.
Strategies to identify consecutive patients included:



Daily review of elective theatre lists.
Daily review of handover sheets/emergency admission and ward lists.
Daily review of theatre logbooks (both elective and emergency).
Inclusion criteria
Summary:
All adult patients with an overnight stay in hospital, undergoing
gastrointestinal surgery (surgery on the oesophagus, stomach, small and large bowel,
rectum and anus), bariatric surgery or hepatobiliary surgery (surgery on the liver,
pancreas, gallbladder and biliary tree)
Age: 18 years or above
Timing: Elective or emergency procedures
Length of stay: Patients with an overnight stay, either preceding or following the
operation
Technique: Open, laparoscopic, laparoscopically-assisted, or laparoscopic-converted to
open procedures
Page | 3
Included procedures:


Surgery on the gastrointestinal tract from the oesophagus to the rectum and
anus.
Surgery on the liver, biliary tree, gallbladder and pancreas.
Excluded procedures:


Day case surgery
Minor anorectal surgery
e.g. surgery on haemorrhoids, rectal prolapse, fistula – unless there was an abdominal incision or
the procedure was laparoscopic

Hernia surgery
Not included unless the procedure required either small bowel or colonic resection.


Transplant surgery
Urological indication
e.g. ileal conduit.


Gynaecological indication
Vascular indication
e.g. open AAA repair.

Trauma indication
e.g. trauma laparotomy.

Interventional radiology
e.g. CT-guided placement of a drain.

Diagnostic procedures
e.g. diagnostic/ staging laparoscopy or laparotomy, endoscopic procedures (e.g. oesophagogastro duodenoscopy (OGD) or colonoscopy), examination under anaesthetic of the rectum
except appendectomies
Page | 4
5.
Results
(Enter/copy data and/or graphs from the DISCOVER Analysis Sheet Tool into the
relevant sections)
Section 1: Demographics
Section 2: Operative details
Section 3: Outcome details
Section 4: Audit Standard Adherence
Section 5: Risk of Operative Complications
Page | 5