Development of a surgical endoscopy database for quality assurance.

In view of the current incorporation of gastrointestinal endoscopy within surgical residency programs and therefore increased performance of these procedures by surgeons, it is appropriate to devise an effective database which allows retrieval of pertinent information for quality assurance (QA) and utilization review (UR) programs. During the development of two complete surgical endoscopy teaching programs, the QA process has been extensively analyzed for the minimal essential information required to perform QA in compliance with regulations of JCAHO and other reviewing authorities. Over the previous five years this information has been gathered on 3098 patients and incorporated into a database which allows for review of the medical record and the endoscopy unit record for QA and UR. Although the data were entered into a computerized database program for ease of data retrieval and analysis, this information can be complied by the "stubby pencil" method in paper files or log books. The QA process is integrated as part of the general surgery QA, not under a separate endoscopy committee. Results demonstrate that the minimal essential data for the medical record included: patient identification data, endoscopist, procedure, additional procedures, medications, indications, preoperative diagnosis, description of procedure, findings, tissue obtained, complications, final diagnosis, and discharge planning. The endoscopy unit record contained: patient identification, endoscopist, procedure, tissue obtained, and suite complications. From these data elements, complete QA was performed and included: completeness of documentation, appropriate indications, complications, endoscopic versus pathologic diagnosis, and unsuccessful procedures. Utilization review included: number of normal procedures, benefits of screening and surveillance procedures, and appropriateness of preoperative evaluation.(ABSTRACT TRUNCATED AT 250 WORDS)

Pharyngoesophageal diverticula.

We reviewed 17 cases of pharyngoesophageal diverticula treated at the Medical University of South Carolina during the period 1955 to 1979. Of these 17 patients, 13 had primary excision of the diverticulum, with no deaths, one recurrence, and two significant complications. One patient with a perforated diverticulum died after simple drainage. The average age of the patients was 68, with a range of 40 to 83 years. The indicence of concurrent serious disease was quite high. We conclude that primary diverticulectomy is the current treatment of choice and is the standard against which other surgical technics must be measured. The place of cricopharyngotomy deserves further evaluation.

A study of the treatment of pit viper envenomization in 45 patients.

Forty-five patients with snake bite were studied: 33 were classified nontoxic and 12 toxic. There were no deaths and four complications in the nontoxic group; two deaths and three complications in the toxic group. The data suggest that rapid recovery is generally to be expected in nontoxic patients regardless of the form of local therapy. The risk of antivenin complications outweighs the minimal therapeutic benefits when administered to most nontoxic patients. If nausea and vomiting are the only manifestations of systemic toxicity antivenin may not be necessary for rapid and complete recovery. The combination of hypotension and bleeding diathesis represents a particularly severe form of toxicity that may result in death if adequate systemic and supportive therapy is not rapidly instituted.