M&M Data Collection FormDepartment of SurgeryPrince of Wales Hospital

Date of M&M meeting:

Team 4

(dd/mm/yyyy)

Ward

(

Type of case Particulars Discharge Summary (please include dates and name of procedures, clinicalcourses and causes of death)

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Ward / Bed No..

For mortality cases:

Referred to Coroner?

/Y"t ì*' tloExpected deaSh?

l* Yes Ø no

For morbidity cases:

Complicationsnecessitatelnterventional Radiologyprocedures?

[- Yes í: No

Complicationsnecessitate ICUadmission?

[* Yes l* no

Complicationsnecessitatere-operation?

ñ Yes f'- t'lo

ls this case aincident?

+ r,¡ YESI

medical

No

Date of Admission: l, I I o1 I )," t -¿. (dd/mm/yyyy)

DateofDeath/Discharge: ll I Ol I 'l,,pl> (dd/mm/yyyy)

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Mortality CaseLYF 67/M

Team 427/12/2012

HPI• Hypertension, COAD

• Attended A&E for low back pain on 18/7/2012 20:41

• Chest pain + tachypoea + tachycardia + transient BP drop at 22:10, but remained conscious

• CXR: widened mediastinum

• ECG: ST elevation in inferior leads

• Bedside USG abdomen: 10cm AAA without free fluid

• Fluid resucitation with 500ml NS + 2 units of unmatched blood

• BP 110/70; Pulse 110/min; H’cue 11.1

• CT thorax + abdomen with contrast: – No thoracic aortic dissection– 11x12cm infrarenal AAA with short neck– Retroperitoneal haematoma

• Anatomy not favorable of EVAR. Decided for open repair

Intra-operation• Right CFA cut down under

LA concomitant with anaesthetic preparation

• Aortic occlusion was inflated at suprarenal level with the support of a 16Fr long sheath under fluoroscopy

Intra-operation• Midline laparotomy after induction

• Rupture at aneurysm neck during dissection resulting in massive bleeding

• Aortic balloon retrieved and was found burst

• Reinsertion of another aortic balloon with bleeding under control

• Developed VF and PEA. Regained pulses after cardioversion and CPR for 16 min

Intra-operation• Infrarenal aortic clamp on after further dissection of aortic

neck

• 16mm tube graft

• Difficult ventilation upon closure of fascia

• Transfer to ICU with laparostomy

• Operation time: 2hr 56min. Blood loss 4500ml

• 10 units of packed cell; 16 units of FFP; 16 units of platelet conc

Post-operation• Multi-organ failure. Started CVVH in ICU

• Developed transient cardiac arrest again on 19/7 required CPR for 1 minute

• ICU and family agreed not for escalation of treatment

• Succumbed at 1150 on 19/7/2012

• Coroner referred. Autopsy was waived.

• Cause of death: Ruptured AAA with massive bleeding

Occlusive Aortic Balloon• Well described in literature for

providing proximal control in rAAA

• Transbrachial and transfemoralapproach

• Concomitant procedure during anaesthetic preparation

• Clamp before cut

Occlusive Aortic Balloon• Bursting of balloon is one of the known

complication

• Related to disease in aortic wall e.g. calcified plaque, mural thrombus

• Associate with high mortality

• To prevent bursting:– Avoid inflation in diseased area– Avoid over-inflation

Date

Team

Presenter

Patient Name

Sex

M & M Meetinq

Thursday 27 December 2012

T4

DT YEUNG YING FUNE

First Name (initial): YF Last Name: LEE

MAge:69

Comments from Ghairperson

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Professor Paul B. S. LaiChairpersonDepartment of Surgery

Follow-up Action: M ruo

tJ Yes (please list the details)

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Hospital AuthoritY Case No: HN12'107765W

Name:

Age at Operation: 56Y

oT start on: 2610912012 at 12"35 0T End on 2610912012 al 15:57 Duration: 3hr 22 min

Pat. Spec.: PRS OT Suite: OT505 Ward: 8C

User Spec.: SUR Div./Team: PRS Disease Group: P&R

Type: Elective Magnitude: Major

Anaesthesia: GA Blood Loss: ml

Anaesthetist:LAM, Wang Leuk Desmond

TSE, King Yan Catherine

Surqeons:Surgeon WONG, Sau Yan

Assistant MO, Wan Leong Kevin

Assistant TAM, Yik Wun

Preoperative Diaonosis:

? Ca left Parotid

OpefatiVe DiaOnOSiS: (Modifier: ?=Provisional; C=ComplicalÌons)

Parotid tumour (239.0)

Procedure:Superficial parotidectomy - left (26.31)

Spegimens sent for Patholoqical Examination:

Findinqs:4cmby4.Scmsofttissuemassinthetailofthe(L)parotidgland.No enlarged lYmPh node.

Procedure Record:

Lazt-S incision.Skin flaps raised.Tailandlowerlobeofthe(L)parotidmobilisedfromitsbed.(L) great auricular nerve divíded as it entered he gland (the tumour).

(L) facial nerve trunk identified but tracing for waids was unusually diffiuclt due to distortion by the

tumour mass.Facio-venous plane developed and traced'(L) super-ficial parotidectomy done'Haemostasis.Wound irrigated with clean NS.One small sized JP drain.Wound closure with 4/0 vicryl and 6/0 nylon'

Remarks:

Date Signature

WONG, Sau Yan

Page 1 of I

SePtember Meeting RePort

astic, Reconstructive and Aesthetic Surgery

Elective

Ultra-

lntermediateMinor

39

Team

a* coun.led bY coses

Rate20 00o/o

7 69%

Rate

0%

00%

)MPLICATION CASE:

Complication case

996.S?,aFtap failure - totat2017111/16 I MO, Wan Leong Kevìn

39

2012.08.27to

2012.10.22

l" g^

l(g,t

CHIU, Tor Wo(u)M0, Wan LeongKevìn (U)

19 | ComPtication case

998.3 Wound dehesjent - PostoP

2012.09.10 I ZOtZ¡t/ 16 I MO, Wan Leong Kevinto

2012.10,06

10 | ComPtication case

998 59a Wound infection - Postop

7012 09.71 | ZOtZl1 /16 I MO, Wan Leong Kevinto

7012 10.04

M0, Wan LeongKevìn (U)BURD, Andrew(u)TA,M, YiK WUN(Ä)

l1 2.09. 1 3N1 20958717R5 M/73mergency (UM)

¿017.09 111N12101400PPRS F/82ttectìve (UM)

2017,09.74HN1 21 06247QPRS F/50E[ective (M+)

7012.09 76HN1 21 07765WPRS F/56Etective (M+)

E878 .2

996.52

86.69

145 0

83, B2

Suroica[ ooeration with anastomosis, bypass' .

or p"raft. with naturaI or artificia[ tissues useo

ás imptãnt causing abnormaI patient react atoperation

Partiat necrosis of tram ftaPnot fRÄJv\, chimeric muscutof ascìocutaneous

CHIU, Tor Wo(u)LEE, Ka YinGregory (U)

Ftap reconstruction to scatp , teft dls-t:ä.11

freb , fasciocutaneous , anterotaterat thìgn

aIt

ftap (83.82)

Partìat thickness skìn graft

7@P

WONG, Sau

Yan (U)M0, Wan LeongKevin (A)TAM, Yik Wun(A)

Þ%Cancer; riqht - cheek mucosa; stage lV.A (cr lJtl io ú o I ; nistotogy: squamous cett

carcinoma (145.0)

Ftap reconstruction to buccat., riqft I dis-\1nt

pedicte , myocutaneous , pectoratis muscteftap (83.82)

EB78. 8

v10. 3

611 .8

85. 89

86.75

239.0

76.31

Other soecified surgicat operations andprocedures causing abnormal patlent reactlon,or later comPÌlcation

Pas[ history of Cancer of teft breast (V10'3)

Breast defect, Post mastectomyPost BCT

Mammoptasty

Revision of Pedicte or ftaP graft

Parotid tumour

Superficiat Parotidectomy - teft

3

7017.09.25to

2012.09.79

Compticatton case

997.01a Post-oP NeurologicaI Cx

2012/11116 I

CN Vll PatsY

F4. ù u,I Total Case : 4 (0S/0U/04) | Male : 1 | Femate :

i Compteted Casê : 4 | Missing Case : 0 I

3 | Etective:3 | Emergency:1 | Death:0 I Compucation:4 I

September 2012 Meeting report vl.3 12012'll'23 ì¿4 u ú ry d.; Øvzz/

PRAS Team

55yr old female

First seen in clinic 14/04/12

Left parotid swelling for several months

Asymptomatic

Firm mass

Left angle of mandible

6cm x 5cm x 4cm

No cervical lymph nodes

Facial nerve: intact

Multiple lobulated masses in bilateral parotid glands

Features suggest lipoma’s

MRI +/- FNAC arranged for further evaluation

Multiple lobulated massesBilateral parotid glandsInvolves superficial & deep lobes?Lymphoma ?salivary gland tumour

FNAC: Suspicious of low grade epitheial neoplasm – Need to rule out acinic carcinoma

Left superficial parotidectomy 4cm x 4.5cm tumour in tail of parotidLeft GAN dividedFacial nerve identifiedTracing of nerve difficult due to distortion by tumour massDuration: 3hrs 22mins

Noted complete left facial nerve palsy

Patient reassured this is likely temporary

Discharged home day 3 post op

Last seen in clinic 6/12/12Left facial nerve paralysisNo function/recovery

Pathology: Benign - Oncocytoma

Benign tumour

80% occur in the parotid glands

7% bilateral involvement

Represent 1% of all parotid tumours

Occurs in 6th decadeMale & females effected equallySimilar to Warthin’s tumour & pleomorphic adenomaSlow growingAsymptomatic

Surgery

Recurrence rate: 20%

Date

Team

Presenter

Patient Name

Sex

M & M Meetinq

Thursday 27 Ðecember 2012

PRAS

Dr MO WAN LEONG, KEVIN

First Name (initial): KC Last Name: lP

Age : 50

Comments from Ghairperson

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Professor Paul B. S. LaiChairpersonDepartment of Surgery

Follow-up Action: M No

tr Yes (please list the details)