census 2008 final

8/7/2019 Census 2008 FINAL

1/51

Census 2008(1st Jan 31st Dec)

Surgery Unit I,

Department of Surgical Disciplines,AIIMS


2/51

No. of Admissions 1085

No. of Surgeries 867

Elective Cases 762

Emergency Cases 105


3/51

Total -867

Elective 615

Emergency 105

Day care 147


4/51

Distribution of cases- Type of

AnaesthesiaAnaesthesia No. of cases

GA / SA 720

Local 147

Total 867


5/51

ELECTIVE


6/51

System Wise Distribution

Head and Neck 113

Hepatobiliary 152

Breast 117

Hernia 33

Adrenal 8

Vascular 43Soft tissue tumour 18

Thoracic Surgery 4

GI Surgery 62

Dermatological malignancies 12

Splenectomy 19

Genito-urinary Surgery 15

Miscellenous 19

TOTAL 615


7/51

Breast operations-117

Modified Radical Mastectomy 58

MRM + LD flap 2

MRM + DIEAP fasciocutaneous free flap 2

MRM + TRAM flap 2

WLE + SLNB +/- ALND 25

WLE + SLNB +/- ALND + Brachytherapy ports insertion 2

Wire guided WLE 1

Radical mastectomy 2Simple mastectomy Pagets disease 2

Axillary Lymph Node Dissection 2

Simple mastectomy + Axillary sampling 1

Breast Cancer - 99


8/51

Cont.

Male Breast cancer- Radical mastectomy 2

Reduction Mammoplasty 2

GynaecomastiaSubcutaneous mastectomy 3

Inferior dermoglandular flap mastectomy 1

4

Simple mastectomy- Phylloides tumor 2

Giant fibroadenoma 5

? Malignancy TB abscess 1

Radical duct excision 2


9/51

Thyroid-81

Hemithyroidectomy 35

Sub-total thyroidectomy 11

Total thyroidectomy 13

Near total thyroidectomy 4

Completion thyroidectomy 7

Total thyroidectomy + MRND 4

Total thyroidectomy + Central compartment excision 1

T

otal thyroidectomy+T

racheostomy 2Reexploration for high drain output 2

Total thyroidectomy+ Adrenalectomy 1

Total thyroidectomy +Neck paraganlioma excision 1


10/51

NeckParathyroid

Miniparathyroidectomy 15Neck exploration 2

Video assisted parathyroidectomy 1

Salivary gland operationsParotid Surgeries

Superficial parotidectomy 5

Total parotidectomy 1

Total parotidectomy + P.major flap 1Superficial parotidectomy+ Enucleation (B/L) 1

Incision and Drainage for abscess 1

9

Excision of Submandibular gland 2


11/51

Neck Contd...

Others

Neck dissections-MRND

(Already mentioned)

5

Cystic hygroma 1

Torticollis 1

Paraganglioma 1


12/51

Biliary-145Laparoscopic cholecystectomy 110

Lap to Open Cholecystectomy 9

Open Cholecystectomy

On anticoagulants (post valve replacement) 3

? CAGB 2

GB polyp 1

6

Lap cholecystectomy+ Other procedures

(Vaginal Hysterectomy, Tubal ligation,

Ovarian cyst excision, Umbilical hernia)

7

CBD Exploration+ T-tube 1

CBD Exploration + Choledochoduodenostomy 8

Excision of choledochal cyst + Hepaticojejunostomy 2

Hepaticojejunostomy for Biliary stricture 1

Explorative laparotomy + Biopsy -?CaGB 1


13/51

Hydatid Cyst of liver DeroofingLaparoscopic 2

Open 3

5

Simple Liver Cyst laparoscopic drainage 1

Liver-6

Pancreas-1

Whipples procedure 1


14/51

Splenectomy-19

Idiopathic Thrombocytopenic purpura 9

Haemolytic anaemia + Gall stone disease

(Splenectomy + Cholecystectomy)

5

Hereditary Spherocytosis 3

Diagnostic ( Isolated NHL of Spleen) 1

Sarcoidosis ( Hypersplenism) 1


15/51

Colorectal -22Hemicolectomy

Ileocaecal tuberculosis 2Carcinoma 3

? Malignancy 2

7

Segmental resection and anastomosis for Colonic

polyp

1

Carcinoma rectum

Abdomino perineal resection 4

Low anterior resection 2

Lap assisted sigmoid colostomy 1

Explorative laparotomy + abandoned 1

8

Colostomy closure 4

Rectal Prolapse

Delormes procedure

2


16/51

Minor Anorectal procedures-3

Haemorrhoids

Stappler haemorrhoidectomy 1

1

Fistula in AnoKharsutra insertion 1

Lay open 1

2


17/51

Oesophagus-1

Transhital Oesophagectomy for CarcinomaOesophagus

1

Stomach-4

Gastrojejunostomy for Gastric outlet obstructionLiposarcoma 1

Carcinoma stomach 1

2

Gastrojejunostomy + Truncal vagotomy for

Gastric outlet obstruction

1

Trichobezoar

Gastrotomy and removal

1


18/51

Small bowel-22Ileostomy closure 6

Stricture Tuberculosis

Stricturoplasty 2Resection and anastamosis 3

5

Delayed fecal fistula post mesh hernioplasty

Mesh removal + resection and anastamosis 2

2

Subacute intestinal obstruction

Mesh removal + adhesiolysis 1

Adhesiolysis 1

2

Malrotation -Ladds procedure 2

Heterotopic pancreas

Resection and anastamosis 1

1

Explorative laparotomy + Biopsy

TB abdomen 2

2

Meckels diverticulum 1

Duodenal Leak Tube duodenostomy + Feeding jejunostomy

( Operated case of Paraganglioma)

1


19/51

Interval Appendicectomy

Laparoscopic 5

Open 5

10

Appendix-10


20/51

Abdomen- 14

Adrenalectomies

Phaeochromocytoma 3

Cushings syndrome 2

Incidentaloma 2

Adrenal carcinoma 2

Adrenalectomy + Parathyroidectomy 1

8

Pack removal post adrenalectomy 1

Paraganglioma

Explorative laparotomy+ Biopsy of paraganglioma 1

Excision of paraganglioma + Rt.Nephrectomy +IVC excision+

reconstruction+ Lt.renal vein reimplantation 1

Excision 1

3

Retroperitoneal tumor

Unresectable 1

? Neurofibroma 1

2


21/51

Genito-Urinary-15

Radical Nephrectomy 5

Penile disorders

Partial penectomy 1

Total Penectomy 1Circumcision 1

3

Testicular disorders

Orchidopexy 5

T

high pouch Implantation of testes forFourniers gangrene 1

6

Ilioinginal block dissection for Osteosarcoma of

Thigh

1


22/51

Herniae -33

Incisional 20

Umbilical 4

Epigastric 1

InguinalMesh hernioplasty + Orchidectomy 1

Recurrent Hernia 2

7

Port site Hernia following Lap Adrenalectomy 1

Mesh removal (already mentioned)

Fecal Fistula 2

Sub acute intestinal Obstruction 1

Recurrent inguinal hernia 1

4


23/51

Arterial - 24

Arterial Pseudoaneurysm 2

Arterio Venous Malformation 8

Arterio Venous Fistula 4

Aorto-Femoral Bypass 1

Aorto-Bifemoral Bypass 1

Stem Cell Therapy for PAD 2

Endovascular Interventions ( Coils and grafts) 5

Abandoned Femoropopliteal Bypass 1


24/51

Venous - 19

SFJ/SPJ Ligation + Perforator Ligation

+/- Stab avulsion

14

Subfascial Endoscopic Ligation of Perforators

(SEPS)

4

Venous Pseudoaneurysm 1


25/51

Soft Tissue Tumors-18

Wide local Excision + Split Skin Thickness grafting 1

Wide Local Excision + Flap 3

Wide Local Excision + Primary Closure 2

Reconstruction for Raw area post excision - Flap 2Excision of lipoma forearm post radical

mastectomy for carcinoma breast

1

Above Knee Amputation

Malignant Fibrous Histiocytoma 1Neurofibroma with deformed foot 1

2

Split Skin Thickness grafting 5

Lipomatosis of Abdominal wall 1

Neurofibroma excision 1


26/51

Thorax - 4

Hydatid Cyst Lung

Wedge Resection 1

Excision of sac 1

2

Hydatid cyst of Erector Spinae- Excision 1

Bullectomy 1


27/51

Dermatological Malignancies-12

BCC WLE + Rotation flap 6

SCC- WLE + Reconstruction 5

Malignant melanoma- Digit amputation+ALND 1


28/51

Surgeries in other Units/Departments-13

Resection and Anastamosis ( Gyn) 5

Ileostomy (Gyn) 1

Adhesiolysis (Gyn) 3

Choledochoduodenostomy ( SUR-3) 1

Total Thyroidectomy (SUR-3) 1

Mesh Hernioplasty (Gyn) 1

Sigmoid Volvulus (Gyn) 1


29/51

Reexplorations( Already mentioned)

Thyroid

High Drain Output 2

Stridor- Tracheostomy 2

4

Post MRM + DIEAP flap necrosis 1

Post WLE + Bleeding for Breast Cancer 1

Post Lap Cholecystectomy + Bleeding 1

Post Bullectomy Pneumonectomy 1


30/51

EMERGENCIES


31/51

Emergencies-105

Oesophageal Perforation 1

Gastric Perforation 2

Duodenal Perforation 17Jejunal Perforation

Resection and anastamosis 1

Exteriorization + feeding Jejunostomy 2

3

Ileal PerforationRepair 2

Ileostomy 13

15

Rectal Perforation- Repair + Loop Ileostomy 1

SMA Infarction Laparostomy 1

Perforation peritonitis 40


32/51

Cont..Open Appendicectomy 13

Intestinal ObstructionObstructed Herniae 5

- Inguinal Herniae 2

- Umbilical Herniae 2

- Femoral Hernia 1

Adhesions 2

Rectal cancer 2Stricture (Resection and Anastamosis) 2

11

Post lap cholecystectomy bleeding 1

Rt. Hemicolectomy

Lower GI bleed 1

Fecal fistula post Appendicectomy(operated PVT) 1

2

Rectus sheath haematoma 1

Feeding jejunostomy 2


33/51

Cont

Neck exploration post Thyroidectomy +

Tracheostomy

2

Total thyroidectomy + Tracheostomy(Emergency) 1

Tracheostomy (Prolonged intubation) 4

Debridement

Necrotizing fascitis 4

Fourniers gangrene 1

Flap necrosis 2

7

Incision and drainage

Pyomyositis 2Gluteal abscess 2

4

Post Wide local excision Breast carcinoma -bleeding 1

Post bullectomy-Pneumonectomy 1


34/51

Cont.

Above knee amputation 3

Below Knee amputation 7

Fore foot amputation 1


35/51

Day care


36/51

Day care-147

Radical Duct Excision 24

Microdochectomy 1

Fibroadenoma 5

Inguinal Herniae 46

Hydrocele 1

Pilonidal Sinus 3Varicocele- High ligation of testicular veins 3

SFJ Ligation+/- stab avulsion 19

Ray/ digit/ toe Amputations 10

Sinus tract exploration 5

Ksharsutra Insertion 4

Debridement 10

Chemoport Insertion 4

Miscellaeneous 12


37/51

Mortality


38/51

Mortality-Data

No. of Operated Elective cases - 6

No. of Operated Emergency cases - 14

No. of Non-operated Elective cases -2

No. of Non-operated Emergency cases -12

Average age group of patients- 51.58 years

Average duration of stay of operated cases- 12.6 days

Average duration of stay of non operated cases- 8 days


39/51

Sl.

No.

Cause No. of

Cases

Operated (20) Non-operated(14)

1 Septicemia 25 Perforation peritonitis 7

Pyogenic liver abscess - 1

Diabetic Foot 2

Necrotizing Fascitis 2

Gastric carcinoma-1

Faecal fistula -1

Strangulated hernia-1

SMA infarct-1

Perforation Peritonitis 2

Diabetic foot-1

Necrotizing fascitis - 3

Pneumonia 2

Faecal fistula -1

2 Advanced

Malignancies

7 Retroperitoneal tumor -2

Osteosarcoma-1

Adrenal carcinoma-1

Breast - 2

HCC-1

3 Aspiration

pneumonia

2 Carcinoma Stomach- 1

Carcinoma Rectum- 1

Cause of Death


40/51

S.No. Age/

Sex

Hospital

stay

Surgery

performed

Cause of

death

Predisposing factors

1. 17/M 5 Perforation

peritonitis

Septicaemia Perforation jejunal, On

Steroids for Minimal change

disease and anticoagulants for

EHPVO

2. 81/M 12 Modifidgrahams

patch

Septicaemia Duodenal perforation,Bronchial asthma on steroid,

CAD

3. 68/M 4 Explorative

Laporotomy+

sigmoid loop

colostomy

Septicaemia Sigmoid perforation

COPD

4. 14/F 11 Explorative

laparotomy +

peritoneal

lavage +

ileostomy

Septicaemia Perforation peritonitis, TB

Perforation Peritonitis Operated


41/51

S.No. Age/ Sex Hospital

Stay

Surgery

performed

Cause of

death

Predisposin

g factors

5. 54/F 35 Resection

and

anastomosis

Septicaemia

shock

Perforation

peritonitis,

Rheumatoid

arthritis +Steroid+post

THR

6. 62/F 22 Grahams

patch repair

Septicaemia Duodenal

perforation,

Post CABG

7. 65/F 2 Explorative

laparotomy+

Ileostomy

Septicaemia Carcinoma

GB with

infiltration

of hepatic

flexure

Perforation Peritonitis Operated


42/51

S.No. Age/

Sex

Hospital

Stay

Surgery performed Cause of

death

Predisposing

factors

8. 48/M 9 Explorative laparotomy Septicaemia SMA embolus

9. 65/M 20 Explorative laporotomy +

resection anastamosis

ileostomytracheostomy

Septicaemia

(Fungal)

ECF post mesh

hernioplasty for

Incisional hernia

COPD

10. 67/M 9 Subtotal gastrectomy+

Gastrojejunostomy

Septicaemia Duodenal blow

out, COPD

11. 42/M 15 Explorative

laparotomy+peritoneallavage

Septicaemia Ruptured Pyogenic

liver abscess,COPD

12. 50/F 36 Strangulated umbilical

hernia+Resection

anastamosis;decompressi

on craniectomy

Septicaemia Strangulated

umbilical hernia,

CAD post

angioplasty, ARF,

MI,CVA

Septicaemia Operated


43/51

S.No. Age/Sex

Hospital Stay

Surgery performed Cause of death Predisposing factors

13. 26/F 15 - Septicaemia Faecal fistula

( Operated PVT)

14. 65/M 17 - Septicaemia Caecal perforation with

status ileostomy ,

COPD

15. 48/M 1 B/L drains Septicaemia Perforation peritonitis

COPD

Septicaemia Nonoperated


44/51

S.No. Age/ Sex Hospita

l Stay

Surgery

performed

Cause of

death

Predisposing factors

16. 50/M 1 Debridement Septicaemia Necrotizing fascitis

17. 50/M 1 Debridement Septicaemia Necrotizing fascitis

18. 52/M 2 - Septicaemia Gangrene , Rt. CIA occlusion

CAD

19. 65/M 1 - Septicaemia Necrotizing fascitis, COPD

20. 70/F 2 - Septicaemia Necrotizing fascitis+DM+

ARF

CAD post angioplasty

Necrotizing fascitis Operated and Nonoperated


45/51


Stay

Surgery

performed

Cause of

death

Predisposing

factors

21. 72/F 8 - Pneumonia Idiopathic

noncardiogenic

pulmonary oedema, DM,GSD

22. 35/F 24 - PUO Carcinoma breast 3

cycles of NAC

Ventilator Assosciated Pneumonia Nonoperated


46/51


Stay

Surgery

performed

Cause of

death

Predisposin

g factors

23. 56/M 18 B/K

amputation

Septicaemia Diabetic

foot,

CHF,CRF,CVA, CAD

24. 60/M 21 A/K

amputation

Septicaemia Diabetic

foot,

DM,Hyperte

nsion, PAD

25. 73/M 26 Dressing Septicaemia Diabetic

foot , CRF,

pace maker

insitu, CAD

Diabetic foot Operated and Nonoperated


47/51

S.No. Age/ Sex HospitalStay

Surgeryperformed

Cause of death Predisposingfactors

26. 36/F 1 - Disseminated

malignancy

Metastatic

Carcinoma

breast

27. 35/F 1 - Disseminated

malignancy

Septicaemia ,

Metastatic

disease

28. 56/M 1 - Disseminated

malignancy

HCC rupture

HCV

Disseminated Malignancies Nonoperated


48/51

S.No. Age/

Sex

Hospital

Stay

Surgery performed Cause of

death

Predisposing

cause

29. 35/F 17 Resection of

ilioinguinal lymph

nodal mass

Disseminat

ed

metastases

0steosarcoma

Metastatic

disease

30. 52/M 8 Explorativelaparotomy+incisiona

l Bx

DVT +pulm.

emboliosm

Retroperitoneal tumor

31. 35/M 10 Palliative

Gastrojejunostomy

Advanced

carcinoma

Metastatic

liposarcoma

32. 28/M 7 Adrenalectomy Recurrence

with

metastases

Adrenal

carcinoma

Metastatic

disease

Disseminated Malignancies Operated


49/51


Stay

Surgery

performed

Cause of

death

Predisposi

ng cause

33. 75/M 8 - Aspiration

pneumonia

Metastatic

carcinoma

stomachCOPD

34. 70/M 4 - Aspiration

pneumonia

Ca. Rectum

COPD

Aspiration Nonoperated


50/51

Thank You


51/51

Complications

Wound infections Thyroid 6

CBD exploration 1

Breast cancer 8

Umbilical mesh hernioplasty 1

Others 6

Flap necrosis

Breast 10 Thoraco epigastric flap 2

LD flap 1

Others 6

census 2008 final

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