Operative Reports Research Articles

EGS SO16 - Retrospective review of adherence of emergency theatres operation notes to Royal College of Surgeons in England Guidelines

Abstract Background Adherence to standardized operation note guidelines is crucial for ensuring patient safety and maintaining high standards of surgical practice. This study aims to evaluate the compliance of emergency theatre operation notes with the Royal College of Surgeons in England guidelines, identifying areas for improvement to enhance documentation practices. Method A retrospective review of 50 patients was conducted on operation notes from emergency theatres. The notes were assessed for adherence to the Royal College of Surgeons in England guidelines. Parameters evaluated included completeness of patient information, surgical procedure details, intraoperative findings, and postoperative instructions. Results There was good compliance in sections such as the name of the operative and assistance, operative findings, and closure. However, improvements are needed in sections such as problems encountered, anticipated blood loss, and the name of antibiotics used. Compliance can be improved by making the notes clearer and more comprehensive. Conclusion Our analysis suggests room for improvement in adherence to postoperative surgical note guidelines. We recommend adding further details such as the name of the scrub nurse, indication, to the operative notes. A postoperative checklist template has been devised to ensure adherence to guidelines and improve documentation practices.

BN SO02 - Cholecystectomy HRG Coding Audit

Abstract Background Incorrect coding practices for elective surgical procedures carry significant financial implications at Trust level. In this project, we aimed to audit the current coding practices pertaining to laparoscopic cholecystectomies performed within the NHS WWL Foundation Trust during November 2021-October 2022 and calculate the financial burden resulting from this. Method A list of 194 patients undergoing a cholecystectomy and their allocated HRG coding at time of discharge was compiled by the coding department. A comorbidity and complication index (CCI) for each of these patients was calculated using the operation note together with hospital and GP records. With this information, the correct HRG coding for each patient was calculated and compared to their allocated coding at discharge to calculate the difference in tariffs generated. Results 69.23% of 194 procedures carried out during the reported time period were coded incorrectly. This amounted to a financial burden of £72,232 lost in potential tariffs, equating to £372.33 per cholecystectomy performed. Commonest CCI of 3 in 29% of patients with corresponding HRG code GA10J Commonest incorrectly allocated coding GA10K denotes a presumed CCI of 0 Conclusion High percentage of incorrectly coded procedures with significant financial implications at Trust level Currenty coding practice often incorrectly presumes a CCI index of 0 with subsequent incorrect GA10K coding. However, the appropriate coding for the vast majority of patients undergoing a laparoscopic cholecystectomy was GA10J. Education and awareness is underway to make improvements at a Trust level before re-auditing of data can commence.

HPB SO67 - An audit to improve the perioperative administration of tranexamic acid (TXA) to reduce the need for peri- and post-operative blood transfusion in major HPB resections

Abstract Background NHS Blood and Transplant (NHSBT) triggered an ‘amber alert’ on 12 October 2022, meaning hospitals have been asked to put in place management plans to protect blood stocks. In line with these measures requested by NHSBT, The Royal College of Surgeons of England recommended using tranexamic acid in all adult surgical patients if more than 500ml of blood loss is likely. Results from the recent POISE-3 clinical trial confirm the quality, safety and cost-effectiveness of tranexamic acid in surgery, where more than 500ml of blood loss is anticipated. Method Patients were identified by searching the Sheffield Teaching Hospital (STH) operation note database using the key words: hepatectomy, pancreatectomy, liver resection, PPPD and pancreaticoduodenectomy. Retrospective case note review identified TXA administration, pre and postoperative haemoglobin level and blood transfusion prescription. Results 49 patients undergoing major HPB resection at Sheffield Teaching Hospitals (STH) from October 2022 to March 2023 were identified. Following the addition of a prompt in the WHO timeout pre-op checklist, a further 24 patients were reviewed. The audit compared the number of patients who received TXA, pre- and post-operative haemoglobin levels and incidence of intra- or postoperative blood transfusion (within 30 days) between the two groups. Including a prompt did not increase the likelihood of a pre-operative dose of TXA being administered. Mean change in haemoglobin and the proportion of patients requiring transfusion remained similar between the two groups. Conclusion Incorporating a preoperative prompt in the WHO timeout checklist did not improve adherence to guidelines for TXA administration in major HPB surgery. Future audits should continue monitoring these trends and investigating further strategies to optimise perioperative blood management. However, there are randomised controlled trials comparing TXA with placebo in liver resection and the recent TAC-PD trial showed that perioperative TXA did not reduce blood loss in pancreaticoduodenectomy.

Enhancing Surgical Operative Note Standards at Doka Hospital, Sudan: A Clinical Audit

Enhancing Surgical Operative Note Standards at Doka Hospital, Sudan: A Clinical Audit

6942 Should there be a consensus statement about managing Inguinal Hernia In females? A Case of Delayed Diagnosis in Complete Androgen Insensitivity Syndrome (CAIS)

Abstract Disclosure: S. Echetebu: None. Introduction: Androgen Insensitivity Syndrome is usually due to a missense mutation that encodes part of the androgen receptor. More than 50% of females with CAIS present with inguinal hernias (4:1 female to male ratio). Previous CAIS studies have estimated the incidence of CAIS to be 0.8% to 2.4% in girls with inguinal hernias. 90% of the girls with CAIS will undergo inguinal hernia repair during childhood. The prevalence of germ cell tumors is estimated as 0.8% therefore, post-pubertal gonadectomy is now the recommended therapy for individuals with CAIS. Clinical Case: We present a case of a 15-year-old patient with primary amenorrhea who underwent bilateral inguinal hernia repair at the age of 5 weeks and was raised as a female. Initial ultrasound imaging at the age of 14 years revealed an absent uterus and complex hemorrhagic cysts of the ovaries. Further laboratory results revealed 46 XY chromosomal analysis, confirming her diagnosis of CAIS. Her laboratory values are: FSH 6.0 mIU/ml (1.0 to 18.6), Prolactin 15.6 ng/mL (<25), 17OHProgesterone 49 ng/dl (<265), Estradiol 30 pg/ml (<47), LH 17 mIU/ml (0.4 -11.7), Anti Mullerian Hormone 368 ng/ml (<13), Testosterone 629 ng/dl (<55 ). Upon our review of her past medical records from a different hospital, the operation note reports that her gonads resembled testes. Gonads were relocated in the abdomen without follow-up or consultation with an endocrinologist. Upon receiving her new diagnosis, the patient experienced significant emotional distress. As a result, both the patient and her family received psychological counseling and were referred to a genetic counselor to assess any potential risks for her younger sister. There is currently no consensus on the management of females with inguinal hernias in the available literature. It is widely accepted to perform gonadectomy. Currently, researchers at NIH are conducting an observational study on the benefits of additional delays in gonadectomy. Although most surgeons are familiar with this condition, it would be beneficial for families and patients to have an early diagnosis and provide appropriate education regarding future sexual encounters and fertility concerns. Conclusion: We propose to initiate a consensus statement for pediatricians, surgeons, and endocrinologists to perform systematic genetic testing in females with inguinal hernia. Such testing may include either a buccal mucosal smear, karyotype, or skin biopsy in all females with inguinal hernias. If the family chooses to delay orchiectomy, it is recommended that during hernioplasty, the testes should be repositioned in a location that allows for easy monitoring using annual imaging. By adopting this methodology, we can increase awareness about the effects of diagnosis and foster discussions among healthcare professionals regarding suitable management options. Presentation: 6/3/2024

Evaluation and Improvement of the Quality of Surgical Operative Notes in the Department of General Surgery at Dongola Teaching Hospital, Sudan.

Background Surgical operative notes are essential for patient care and legal documentation. However, inconsistencies in the quality of these notes at Dongola Teaching Hospital, Sudan, highlighted the need for improvement. In line with guidelines from the Royal College of Surgeons of England (RCSEng), this study aimed to enhance the documentation practices in the hospital by implementing a standardized format. Methods A retrospective audit was conducted over three months at the General Surgery Department of Dongola Training Hospital. In the first audit cycle, 81 surgical notes were assessed, revealing significant deficiencies in adherence to RCSEng standards. An intervention was introduced, including a standardized template, training for surgeons, and widespread dissemination of the new format. A second audit cycle followed to assess improvements. Results In the first audit cycle, adherence to documentation standards was 50.3%, with missing or incomplete information in key areas. After the intervention, adherence improved to 71.9%. Notable improvements included documentation of extra procedures (18% to 100%), prosthesis details (0% to 100%), and antibiotic prophylaxis (71% to 97%). However, a slight decline was observed in postoperative care instructions, dropping from 100% to 90%. Conclusion The introduction of a standardized template and training significantly improved the quality of surgical documentation. Continuous efforts are necessary to maintain these improvements, particularly in areas where adherence remains suboptimal, such as postoperative care instructions.

The Association between the Duration of Anterior Cruciate Ligament Rupture-reconstruction with Meniscal Lesions and Knee Functional Outcomes

Background: Given the controversial correlation between the duration of anterior cruciate ligament (ACL) rupture-reconstruction and knee functional outcomes reported in previous studies, this study aimed to investigate the correlation between the duration of ACL rupture-reconstruction with knee meniscal lesions and functional outcomes. Patients and Methods: This retrospective cohort study was conducted on 221 patients with ACL rupture who underwent ACL reconstruction at a referral hospital in Tehran, Iran, from April 2021 to May 2023. Demographic characteristics and data about the duration of ACL rupture reconstruction were collected using the patients’ clinical documents. The status of knee meniscal lesions had been evaluated using magnetic resonance imaging report or operation note. After that, knee functional outcomes had been assed using Osteoarthritis Outcome Score scale. The correlation between the duration of ACL rupture-reconstruction with knee meniscal lesions and functional outcomes was evaluated using the multivariate regression test. Results: Most patients were male, with a mean age of 28.38 ± 7.33 years. The correlation between the duration of ACL rupture-reconstruction and knee meniscal lesions was statistically significant (P = 0.026); however, the correlation between the duration of ACL rupture-reconstruction with the KOOS questionnaire scale score and all its dimensions as a scale for assessing knee outcomes was not significant (P > 0.05). Conclusion: Although early ACL reconstruction is accompanied by reduced knee meniscal lesions, this cannot improve knee functional outcomes.

ThP7.17 - Improving completeness of operative notes for laparoscopic appendicectomy

Abstract Aim This study aimed to compare the quality of laparoscopic appendicectomy operation notes in the emergency setting to 'Get It Right First Time' (GIRFT) guidelines. To evaluate the effect of the teaching session and operative note checklist in improving the completion rate of operation notes for laparoscopic appendicectomy. Method Retrospective analysis of 19 consecutive operation notes of patients undergoing emergency laparoscopic appendicectomy. Prospective data was then collected on 15 consecutive appendicectomy operation notes post-intervention. 34 recommendations based on GIRFT recommendations 'Best practice for laparoscopic appendicectomy documentation' were used to audit laparoscopic appendicectomy operation notes. Documentation was reviewed by two independent reviewers and scores were given based on GIRFT recommendations. Student's T-test was used to calculate the significance of overall scores and Chi-Squared to calculate the difference between individual categories. Results Mean completeness of operation notes improved from the first cycle (58.5%) to the second cycle (85.5%, P<0.001). There was a significant improvement in documentation of patient positioning (P=0.001), skin preparation (0.035), diagnostic findings (P<0.001), health of caecum (P<0.036), extraction port (P=0.01) and follow-up plan (P=0.03). Conclusion There were many domains of the GIRFT recommendations not addressed prior to this audit. Teaching sessions and checklist distribution lead to a significant improvement in overall completeness of the operation note. Movement towards digitised templates should be made to further comply with guidelines.

EP298 - Assessing the use of a rapid and standardised online operation note for laparoscopic cholecystectomy

Abstract Aims Laparoscopic cholecystectomy is one of the most common operations performed in the UK, with approximately 65,000 procedures performed per year. The operation note is of utmost importance as is documents the procedural steps, highlights peri-operative complications, details post-operative instructions and may act as medico-legal evidence if necessary. At our centre, operation notes are written using a blank online document and we aimed to make the process of writing these documents following laparoscopic cholecystectomy easier and more efficient. Methods We produced a computer based, standardised operation note for laparoscopic cholecystectomy. The document consisted of spaces for key clinical information such as the staff members involved with the operation, whether the procedure was done as an elective or emergency case and the patient’s ASA score. The document also outlined the key operative steps that could be ticked off using yes/no answers, a section for white space answers for additional details and pre-written post operative instructions that could be added to. Results This standardised operation note was well received by colleagues and facilitates rapid and thorough documentation. It ensures all steps are documented and so reduces the risk of omissions. Furthermore, it ensures legibility should it need to be referred to in the future, ensuring medico-legal compliance. Conclusions This operation note is medico-legally more rigorous, ensures legibility and is easier to use for auditing purposes. Producing the document was also an excellent trainee opportunity as it encouraged consideration of the important operative steps and outlining them in a step wise format.

WP5.10 - Improving documentation of Surgical Site Infection Reduction Bundle (SSIRB) use in emergency laparotomies

Abstract Aims Surgical site infections (SSI) are associated with significant morbidity and mortality, substantial costs for hospitals due to increased length of stays, intensive care admissions and hospital re-admissions. NICE and the WHO support evidence based SSI reduction bundles (SSIRB). An evidence based SSIRB consisting of eight steps was implemented in the Surgical Emergency Unit (SEU) of a large teaching hospital to reduce SSI rates after emergency laparotomies. An audit was undertaken to assess documentation of SSIRB use. Methods The first audit cycle evaluated SEU laparotomies in January 2022 (n=31). The operation notes in patients’ electronic records were reviewed to extract SSIRB use. The intervention involved altering the electronic operation note to include a section on SSIRB use, which occurred in October 2022. The surgical team were educated about the importance of documenting SSIRB use and the updated operation note. A re-audit was completed for April 2023 (n=21). Results The first cycle showed that SSIRB documentation was poor (ranging from 0% to 55% for each step). After the operation note was updated, documentation of SSIRB use improved significantly for five of the eight steps. 48% of operation notes used the SSIRB section and documentation was higher for these laparotomies. Conclusions Documentation of SSIRB use improved after the intervention. Trusts are obliged to report accurate post-operative SSI rates. Improved documentation allows evaluation of SSIRB use compliance, enabling SSIRB steps with low compliance to be targeted. A high compliance rate to a SSIRB will reduce SSI rates, ultimately benefiting both patients and trusts.

SP1.1 - The effect of mesh fixation on post-operative pain and recurrence in laparoscopic inguinal hernia repair

Abstract Aims To evaluate post-operative pain and inguinal hernia recurrence following laparoscopic totally extraperitoneal (TEP) or transabdominal preperitoneal (TAPP) techniques. Secondly, in TAPP approach to compare outcomes with method of mesh fixation. Methods 545 patients underwent elective laparoscopic inguinal hernia repair in a single centre, between October 2015 and April 2023. Surgical approach and method of mesh fixation was obtained from operation note. Patients were contacted retrospectively via telephone call. Post-operative pain was assessed using a scale (1-10). Chronic pain defined as pain persisting beyond 3 months. Hernia recurrence defined as new groin lump at site of previous repair. Results 545 patients underwent surgery. 212 did not answer follow-up call, 43 declined to take part in study and 22 had died. 268 analysed; 167 underwent TEP and 101 TAPP inguinal hernia repair. Groups were similar in age and gender. Initial post-operative pain score in TEP group was 4.7 (range 1-10) as compared with 4.5 (range 1-10) in TAPP group.13.8% experienced chronic pain, score of 2.9 (range 2-5) in TEP group compared with 16.8%, score of 2.7 (range 2-5) in TAPP group. Hernia recurrences were similar between groups; 4.8% and 4% respectfully. Neither mesh-fixation or non-fixation techniques were found to affect post-operative chronic pain (p=0.8). Patients undergoing tacker fixation reported less hernia recurrence, 1.7% and 5.1% respectfully. No significant difference noted between absorbable and metallic tackers in terms of chronic post-operative pain and recurrence. Conclusion Mesh placement without fixation produced similar post-operative pain but a higher hernia recurrence than mesh-fixation techniques.

EP427 - Are we following the RCS England Guidelines for documentation of the operation note for a laparoscopic appendicectomy: A complete audit loop

Abstract Introduction The audit outlines the importance of adhering to RCS England Guidelines for documenting laparoscopic appendicectomies. Following these guidelines ensures standardized documentation, facilitating effective communication and promoting patient safety. Moreover, it underscores the significance of recording key procedural steps and techniques employed during the operation. It highlights the guidelines' emphasis on legible, timely, and complete documentation, emphasizing the role of the operation note as a legal document. Method This audit involved collecting data from September 2022 - August 2023 for the first loop to analyse operative notes of 92 laparoscopic appendicectomy cases. For the second loop, after introducing an electronic procedure-specific checklist as a guide, we reviewed 30 notes prospectively over a 2-month period (November-December 2023). The notes were compared against RCS England ‘Good Surgical Practice’ 2014 Guidelines using 18 parameters. We assessed for compliance with the guidelines and the legibility of notes. Results After introduction of a checklist, average compliance with guidelines increased significantly in 9 of the 18 parameters assessed, 6 remained unchanged at almost 100% compliance. Two key areas for emphasis were identified: instructions for post-op antibiotics (83%), DVT prophylaxis (53%). The most noticeable lack of documentation was in the gynaecological findings of females, recorded in only 13% of cases. There has been a noticeable effort in improving the legibility of the notes. Conclusion Introduction of a checklist increased compliance with guidelines. The comprehensive documentation will ultimately promote optimal patient outcomes and advance the overall quality of surgical care.

The risk of developing pseudomyxoma peritonei from a non-perforated low grade appendiceal mucinous neoplasm found at appendicectomy

IntroductionLow-grade appendiceal mucinous neoplasms (LAMNs) are classified as non-perforated (pTis, pT3) or perforated (pT4), and considered precursors of pseudomyxoma peritonei (PMP). This study aims to quantify the risk of developing PMP from pTis and pT3 LAMNs. Materials and methodsRetrospective analysis of a prospectively collected database identified LAMN patients referred to a specialist centre from 2004 to 2019. pT4 LAMNs and other appendix tumours were excluded. All patients had specialist review of their pathology, operation note, and a CT scan (at least 6 weeks post-operatively). Surveillance CTs were then performed at 6, 12, 24, 36, 48, & 60 months, with tumour markers (CEA, CA19-9, CA125). Results193 pT3/pTis LAMN patients were included (pTis = 153, pT3 = 40). Median follow-up = 6.45 (3.91–22.13) years, M:F ratio = 1:1.57, and median age = 57 (23–83) years. Initial surgery included: appendicectomy (67 %), appendicectomy + visceral resection (6 %), and right hemicolectomy (27 %). R1 resections were identified in 5/193 patients (2.5 %). 3 R1 patients underwent re-operation (2 caecal pole excision and 1 ileocecectomy), none of which had residual tumour. 8/193 patients (4 %) were lost to follow up. None of the remaining 185 developed PMP. ConclusionThis is the largest reported series of pTis/pT3 LAMNs with standardised follow-up in the literature. LAMNs correctly classified as pT3/pTis (after careful specialist review of pathology, operation note, and a baseline post-operative CT) have negligible risk of developing PMP and should have low intensity surveillance. If completely excised, further surgery is not indicated. R1 resections should be considered on an individual basis at a specialist centre.

A Study in Wad Madani, Sudan: Are We Documenting Operation Notes Effectively?

Operative notes represent the critical record of a surgical procedure, encompassing comprehensive details encountered throughout the operation. Recognizing the importance of comprehensive documentation, the Royal College of Surgeons (RCS) developed the Good Surgical Practice guidelines, which emphasize accurately recording every procedure and specifying the necessary parameters for each operative note. These guidelines help maintain high standards of surgical care and patient safety. A retrospective review of 88 orthopaedic surgery operative notes for fracture neck of femurs was conducted at Gezira Centre for Orthopedic Surgery and Traumatology (GCOST) from March 12 to May 28, 2022. The review assessed 18 parameters against RCS guidelines.Statistical analysis was performed using Statistical Product and Service Solutions (SPSS,version 25.0; IBM SPSS Statistics for Windows, Armonk, NY), which facilitated comprehensive data examination. In 37 cases (42.05%), the operation notes were written by a medical officer. In 29 cases (32.95%), an orthopaedic resident authored the notes. A specialist documented the notes in 21 cases (23.86%), and a consultant wrote the notes in one case (1.14%). Over 90% of the notes included surgeon and assistant names, procedure names, operative diagnoses, operative procedures, prosthesis details, deep vein thrombosis (DVT) and antibiotic prophylaxis, and signatures. The name of the theatre anaesthetist, elective/emergency details, and additional procedures with reasons were absent in all notes. Less than 50% of the notes documented the time of the procedure, type of incision, operative findings, anticipated blood loss, closure technique specifics, and complications. The study emphasizes the shortcomings in the operating notes, underscoring the necessity for training initiatives to enhance the recording by medical officers and orthopaedic trainees. Implementing structured templates that adhere to RCS standards can improve the comprehensiveness and consistency of operating notes, effectively resolving existing discrepancies. Regular audits and feedback sessions are essential for identifying and rectifying persistent issues. It is recommended to arrange workshops and seminars to educate medical officials and trainees on the skills of efficient note-taking and thorough documentation procedures.

Bridging the Gap: Can Large Language Models Match Human Expertise in Writing Neurosurgical Operative Notes?

Proper documentation is essential for patient care. The popularity of artificial intelligence (AI) offers the potential for improvements in neurosurgical note-writing. The study aimed to assess how AI can optimize documentation in neurosurgical procedures. Thirty-six notes were included. All identifiable data were removed. Essential information, such as perioperative data and diagnosis, was sourced from these notes. ChatGPT 4.0 was trained to draft notes from surgical vignettes using each surgeon's note template. One hundred forty-four surveys, with a surgeon or AI note, were shared with three surgeons to evaluate accuracy, content, and organization using a five-point scale. Accuracy was the factual correctness. Content was the comprehensiveness. Organization was the arrangement of the note. Flesch-Kincaid Grade Level (FKGL) and Flesch Reading Ease (FRE) scores quantified each note's readability. The mean AI accuracy (4.44) was not different from the mean surgeon accuracy (4.33, p = 0.512). The mean AI content (3.73) was lower than the mean surgeon content (4.42, p < 0.001). The mean AI organization (4.54) was greater than the mean surgeon organization (4.24, p = 0.064). The mean AI note's FKGL (13.13) was greater than the mean surgeon FKGL (9.99, p <0.001). The mean AI FRE (21.42) was lower than the mean surgeon FRE (41.70, p <0.001). AI notes were on par with surgeon notes in accuracy and organization, but lacked in content. Additionally, AI notes utilized language at an advanced reading level. These findings underscore the potential for ChatGPT to enhance the efficiency of neurosurgery documentation.

1088 The Quality of Information Recorded in Neurosurgical Operation Notes: A Closed Loop Audit

Abstract Introduction Operation notes are critically important documents which serve as record for significant events in the lives of patients. They serve multiple functions, but chiefly to help guide peri-operative management. Surgeons must keep records that are accurate, thorough, and readable. This is fundamental part of the GMC’s Good Medical Practice as well as the Royal College of Surgeons of England Good Surgical Practice guidelines which lays out 18 various parameters for what should be included in an operation note. Aim This retrospective audit aimed to evaluate the compliance of neurosurgical operation notes with the Royal College of Surgeons guidelines, identifying areas for improvement. Method All neurosurgical procedures between October 1 and October 31, 2023, at a Major Trauma Centre in the West Midlands were retrospectively audited. Two independent reviewers used a standardized proforma in Microsoft Excel for data extraction, comparing compliance. Results 91 operation records were examined and found high compliance (100%) in key fields: date, surgeon's name, assistant's name, operative procedure, operative diagnosis, and signature. Negligible compliance was found in identification of prosthesis (0%), estimated blood loss (1%), extra procedures (1%), elective/emergency classification (1%), time (4%), and problems/complications (19.8%). Notably, detailed post-op instructions were lacking in over 1 in 3 operation notes, with 19.7% omitting DVT prophylaxis, and 20% neglecting clip/suture removal instructions. Conclusions While certain aspects showed exemplary compliance, critical deficiencies were identified, particularly in post-operative instructions. A template proforma for post op instructions is required in addition to more targeted guidelines for operation notes within neurosurgery.

Video Documentation in Thyroidectomy and an Evaluation of Operative Notes.

Introduction Accurate and detailed documentation of surgical operation notes is crucial for post-operative care, research and academic purposes, and medico-legal clarity. Several studies have shown their defiency and inaccuracy sometimes, and some methods have been proposed to make them more objective. This study aimed to evaluate the completeness of thyroidectomy operative notes in a tertiary center and to assess the adequacy of video documentation by comparing it to the corresponding operative notes. Methods A retrospective review of thyroidectomy operative notes from 2010 to 2020 at King Abdulaziz University Hospital,Jeddah, Saudi Arabia, was performed to ensure completeness. Subsequently, 15 thyroidectomies were video recorded, and their notes were compared to the corresponding written operative notes. The completeness score was calculated based on an item list that included items that had to be included in an operative note. An independent samples t-test was used to compare the completeness score means between the two groups. One-way analysis of variance was used to compare the completeness score means between two or more groups. Result A total of 385 thyroidectomy-operative notes were retrospectively reviewed. The completeness scores ranged between 6% and 89% for the various items that had to be documented, with a mean of 54.47%. The mean score of the video-documented operative record was 83.86%±12.84%, which was significantly higher than the corresponding written operative notes (47.53%±18.06%) (p <0.001). Conclusion Video documentation showed significant improvement compared to the corresponding written and retrospective operative notes. Video recording can also be a valuable tool when teaching anatomy and surgical skills and conducting research.

639 Good Surgical Practice: Operation Notes in a Mixed EPR/Paper System

639 Good Surgical Practice: Operation Notes in a Mixed EPR/Paper System

336 Elective Operative Note Compliance in General Surgery

336 Elective Operative Note Compliance in General Surgery

535 Improving the Quality of Consent Forms and Operation Notes for Laparoscopic Appendectomies Using the Best Practice Standards Outlined in Getting It Right First Time (GIRFT)

535 Improving the Quality of Consent Forms and Operation Notes for Laparoscopic Appendectomies Using the Best Practice Standards Outlined in Getting It Right First Time (GIRFT)