Overview
Definition:
A surgical registry is a systematic collection and analysis of data on surgical procedures, patients, and outcomes
It serves as a powerful tool for quality improvement, research, and education in surgery
Key objectives include tracking surgical performance, identifying best practices, monitoring complications, and informing policy decisions
For DNB and NEET SS aspirants, understanding registry data fields is crucial for interpreting research and understanding evidence-based surgical practices.
Importance:
Surgical registries are vital for standardizing care, facilitating research, and driving quality improvement initiatives
They provide objective data to assess the effectiveness and safety of surgical interventions, identify areas for improvement, and benchmark performance against peers
This knowledge is essential for residents to critically appraise literature and contribute to evidence-based medicine.
Scope:
Registries can be disease-specific (e.g., breast cancer registry), procedure-specific (e.g., hip arthroplasty registry), or patient-focused
They capture a broad range of data from patient demographics to surgical technique, anaesthesia, operative details, and postoperative outcomes
A well-designed registry captures data that can answer specific clinical questions and support quality metrics.
Patient Demographics
Identification:
Unique patient identifier
Date of birth
Age at the time of surgery
Sex
Ethnicity
Body Mass Index (BMI).
Comorbidities:
Presence and severity of comorbidities: Diabetes Mellitus (DM), Hypertension (HTN), Coronary Artery Disease (CAD), Chronic Obstructive Pulmonary Disease (COPD), Renal Insufficiency, previous CVA
Use of validated scoring systems like Charlson Comorbidity Index.
Lifestyle Factors:
Smoking status (current, former, never)
Alcohol consumption
Recreational drug use
Previous surgical history and outcomes.
Socioeconomic Status:
Occupation
Insurance status
Geographic location (urban/rural)
Educational attainment, as these can influence access to care and outcomes.
Surgical Procedure Details
Procedure Information:
Name of the procedure performed (e.g., laparoscopic cholecystectomy, inguinal hernia repair)
ICD-10 or other coding system codes
Date and time of the procedure
Surgeon and assistant names and credentials.
Approach And Technique:
Open vs
Minimally Invasive Surgery (MIS) - laparoscopic, robotic, endoscopic
Specific surgical technique employed
Use of implants, meshes, or prosthetics with details (manufacturer, model number).
Duration And Blood Loss:
Estimated operative time in minutes
Estimated blood loss (EBL) in mL
Requirement for blood transfusion (number of units).
Intraoperative Findings:
Any unexpected findings
Operative difficulty
Need for modification of the planned procedure
Biopsy taken and sent for histopathology.
Anaesthesia And Perioperative Care
Anaesthesia Type:
General anaesthesia
Regional anaesthesia (spinal, epidural)
Local anaesthesia
Sedation
Name of anaesthesiologist.
Anaesthesia Duration:
Duration of anaesthesia in minutes
Administration of specific anaesthetic agents and adjuncts.
Fluid Management:
Intraoperative intravenous fluid administration (type and volume)
Urine output monitoring.
Preoperative Medications:
Prophylactic antibiotics (drug, dose, timing)
Prophylactic anticoagulation
Steroids
Pre-operative fasting instructions adherence.
Postoperative Outcomes And Follow Up
Immediate Postoperative:
Length of stay in recovery room
Vital signs on discharge from recovery
Pain score
Requirement for analgesia.
Hospital Stay:
Total length of hospital stay in days
Ward or ICU admission
Mobilization status on discharge
Diet progression.
Complications:
In-hospital complications: wound infection (superficial, deep), surgical site infection (SSI) with pathogen if cultured
Pneumonia
Urinary tract infection (UTI)
Deep vein thrombosis (DVT)
Pulmonary embolism (PE)
Haemorrhage
Re-operation (indication, date)
Mortality (date, cause).
Long Term Follow Up:
Scheduled follow-up visits (dates, clinical assessment)
Patient-reported outcomes (PROs) using validated questionnaires (e.g., SF-36, specific disease-related quality of life scores)
Recurrence of disease
Late complications
Functional status at 6 months, 1 year, etc.
Data Quality And Validation
Data Entry Process:
Method of data entry: manual, electronic health record (EHR) integration
Data validation rules at the point of entry
Training for data abstractors.
Data Accuracy:
Audits of data accuracy and completeness
Comparison with source documents
Reconciliation of discrepancies.
Data Security And Privacy:
Compliance with HIPAA/local data protection laws
Anonymization and de-identification of patient data
Secure data storage and access controls.
Data Analysis And Reporting:
Frequency of data analysis and reporting
Key performance indicators (KPIs) tracked
Use of statistical software
Dissemination of findings (publications, presentations).
Key Points
Exam Focus:
Registries are evidence-based tools
DNB/NEET SS questions may involve interpreting data from registries, understanding limitations of studies based on registries, and comprehending quality improvement metrics derived from them
Key data fields are crucial for understanding surgical outcomes.
Clinical Pearls:
Accurate and complete data entry is paramount for the utility of any registry
Standardized data definitions are essential for comparability across institutions
Focus on capturing actionable data that can drive improvements in patient care and surgical outcomes.
Common Mistakes:
Incomplete data collection, inconsistent data definitions, poor data validation leading to inaccuracies, and failure to analyze or act upon registry data
Over-reliance on retrospective data without prospective validation can also be a pitfall.