Miscellaneous
Patient's weight is 113 pounds. His weight has not changed in the 6 months prior to OR (TURBT), but his BMI (16.64) is considered to be underweight and there is a note from nutrition stating "patient has history of bladder cancer, COPD, acid reflux, smoker, and ETOH abuse. His appetite is normal. He drinks up to 3 Ensures each day at home. Nutrition Diagnosis: Underweight related to increased nutrient needs. Diet Recommendation: an additional diet order of ensure with lunch to increase to BID with meals. monitor PO intake and weight". Does this meet criteria for 10% weight loss in 6 months prior to OR?
a- No
b- Yes
a- No
Does not meet definition as weight did not change during the 6 months prior to surgery
Postop patient calls into the clinic on POD5 and states "I was rubbing the site and pus came out". The MD prescribed antibiotics but the patient never came in to be seen. How should the SQN capture for the Superficial SSI variable?
a- No
b- Yes
a- No
Not enough information as presented for a definite capture. It could meet definition using 1st criterion of pus present but could also be a stitch abscess or it may not have been pus. Would look to see if a photo was sent in to capture wound appearance, like in a telehealth appointment.
Patient presents postop to an outside hospital and is diagnosed with Sepsis. Documentation shows culture positive and Pseudomonas and has elevated (positive) lactate and WBC count, but vital signs that are scanned are all normal. How should the SQN capture for the Postoperative Sepsis variable?
a- No Capture
b- Sepsis
c- Severe Sepsis/ Septic Shock
a- No Capture
Does not meet definition because the VS were normal
Patient was undergoing an ENT procedure. MD note states "as we isolated the neoplasm, it became readily apparent that it was wrapped around and invasive into several branches of the facial nerve which were intentionally transected in order to remove the tumor out in its entirety." The patient has facial droop and mandibular weakness, but can fully close his eye, postoperatively. How should the SQN capture for Peripheral Nerve Injury?
a- No
b- Yes
a- No
does not meet definition since it was intentionally transected
In the NSO Quarterly Report, a patient's death is reported under which surgery for the predicted and observed 30-day mortality graph?
a- First CPT eligible and assessed surgery
b- First surgery, regardless of CPT eligibility
c- Last CPT eligible and assessed surgery
d- Last surgery, regardless of CPT eligibility
a- First CPT eligible and assessed surgery
predicted and observed is always assessed cases
True or False: If in a status report, a facility has 10 or more EBNAs, NSO will notify Facility SQN, Facility Chief of Surgery, VLSN, and VCSC. If 50 or more EBNAs, NSO will also notify facility Chief of Staff and VISN CMO.
a- False
b- True
b- True
EBNA (Eligible but Not Assessed) cases require further action by the SQN. All VASQIP eligible case must be assessed or appropriately excluded to comply with VASQIP regulations. Note: Mandatory CPT codes may NOT be excluded for any reason.
Patient history states: Past medical history of HLD, HTN, OSA, DM Type 2, PVD, CAD (history of CABG x3, LIMA to LAD, SVG to PDA, SVG to Diag, DES to LCX). Chief complaint is severe pain to left lower extremity and ulceration of his foot. He denies SOB, dizziness, fatigue, or chest pain. He does report occasional dyspnea on exertion but this is chronic and stable. He is able to ambulate without assistance although his gait is impaired. How should the SQN capture for the Congested Heart Failure variable?
0 = N card Dx, CHF, or Sx;
1 = Y card Dx/CHF, N Sx;
2 = Y card Dx/CHF, Y mild Sx;
3 = Y card Dx/CHF, Y mod Sx;
4 = Y card Dx/CHF, Y Sx at rest;
5 = N card Dx/CHF, Sx unknown;
6 = Y card Dx/CHF, Sx unknown
0 = N card Dx, CHF, or Sx;
Definition states: "indicate whether the patient has congestive heart failure if the patient chart or patient self-report indicates a history of congestive heart failure within the 30 days before surgery" Supplemental states "this variable is to capture CHF and not other cardiac diseases"
A total hip arthroplasty had multiple falls post-op and within 30 days of surgery, was readmitted due to fall with traumatic left prosthetic hip dislocation. He had a closed reduction with conscious sedation in the operating room, no skin incision, just reduction of the dislocation. The hip prosthesis had no defect, was not compromised, fully functional. How should the SQN capture for the Graft/Prosthesis/Flap Failure variable?
a- No
b- Yes
b- Yes
It required additional intervention via return to the operating room. Failures for any cause (infection, mechanical, other) are included. This was a failure due to trauma injury. would capture.
Postop patient was transferred from VA to another hospital for tests on POD7. Patient had been having seizures. EMS wanted to protect his airway during transfer so they re-intubated the patient. There is no documentation whether the patient was ever "bagged" or placed on any kind of ventilation assist other than oxygen. He was extubated when he arrived to the other hospital. What is the correct response for Out-of-OR reintubation?
a- No
b- Yes
a- No
Was not for ventilator support, therefore does not meet definition.
For a Postop Patient within 30 days, MD note stated "I reviewed the records provided by outside hospital. Patient was admitted with a pulmonary embolism documented by CT angiogram. He was placed on heparin and then transitioned to a apixaban. He was seen by pulmonary who recommended 6 months of anticoagulation with apixaban. He was also noted to have deep venous thrombosis in his upper extremity on doppler ultrasound. He was treated as an inpatient for 4 days and released on apixaban." How should the SQN capture the Pulmonary Embolism variable? (How should the SQN capture the DVT variable?)
a- No
b- Yes
b- Yes
Meets definition since MD note confirmed use of CT scan to diagnose.
Patient is a 65 Y/O MALE s/p cervical laminectomy December 8 and admitted to the postop surgical floor. Returned to the OR December 11 for hematoma evacuation. Patient admitted to ICU on ventilator for airway protection. Dec 12 patient agitated and self extubated. MD placed patient on CPAP after self-extubation until Dec 15. What is the correct response for post-op ventilator > 48 hours variable?
a- No
b- Yes
a- No
CPAP is not an intubation or ventilator, therefore would not meet >48 hours.
If the creatinine is slowly increasing from a preoperative value of 0.57mg/dl to a postop final 5.0mg/dl before trending down, for the postop progressive renal insufficiency variable, which date does the SQN enter into the assessment?
a- Date creatinine level reached 2.58 mg/dl or greater
b- Date of maximum creatine level reached of 5.0 mg/dl
a- Date creatinine level reached 2.58 mg/dl or greater
Date met definition so therefore report date creatinine reached 2.58
In the NSO Quarterly Report, a patient's death is reported under which surgery for the unadjusted 30-day mortality cumulative event plot?
a- First surgery, regardless of CPT eligibility
b- Last surgery, regardless of CPT eligibility
c- First CPT eligible surgery
d- Last CPT eligible surgery
e- First CPT eligible and assessed surgery
f- Last CPT eligible and assessed surgery
b- Last surgery, regardless of CPT eligibility
Unadjusted means all cases, so last surgery, regardless of CPT eligibility
Patient underwent a transurethral resection of bladder tumor (TURBT) and has an anterior bladder resection. The next day, patient is taken back to surgery for laparoscopic repair of posterior bladder wall blow out. Op note states post diagnosis is repair of iatrogenic bladder perforation. What is the correct response for the wound disruption variable?
a- No
b- Yes
a- No
Bladder is not part of the muscularfascial layer
Patient is admitted for hernia surgery and undergoes a laparoscopic hernia repair. He is administered a regional block for anesthesia. During surgery adhesions are encountered so a general anesthetic is administered. Which is correct response for the principle anesthesia technique?
a- General
b- Epidural
c- Spinal
d- Regional
e- MAC
f- Local
g- No Anesthesia
a- General
General is higher level then regional
Patient underwent a Vascular angiogram/ angioplasty (VASQIP eligible case). Patient returned to surgery POD 10 for a toe amputation (non-VASQIP eligible). The toe incision opened up related to the patient's non-compliance with weight bearing POD 7. The wound probed down to the bone. The wound disruption meets the VASQIP definition for the toe amputation. Is the wound disruption captured for the VASQIP eligible angioplasty case?
a- No
b- Yes
a- No
A new supplemental has been added (3/8/2022) stating "The wound disruption appears to be related to the Operation". This statement means this variable would only be captured if the related operation was the assessed case. Similar to SSI variables.
A patient has a history of lymphoma and underwent whole body radiation. He is now undergoing cholecystectomy. What is the correct response for the history of radiation therapy to planned surgical field variable?
a- No
b- Yes
a- No
Per supplemental "Patient with history of whole body radiation for lymphoma, now undergoing a cholecystectomy, answer 'no'".
Patient's past procedural history includes a prior Patent Dictus Arteriosus performed in the cath lab. How would the SQN capture this in the Prior Heart Surgery variable?
a- None
b- CABG, only
c- Valve, only
d- CABG/ Valve
e- Other
f- CABG/ Other
a- None
Per supplemental, "Prior heart surgery would require participation of a cardiac surgeon."
Intraoperative record: Primary Surgeon: Chief resident Dr. A, PGY 5. First Assist: Resident Dr. B., PGY 3. Attending Surgeon: Dr. C. What is the correct response for post graduate surgical year variable?
0
1
2
3
4
5
6
7
8
9
10
11
12
PGY 5, primary surgeon is what this question is asking
The patient is admitted to the hospital after falling in his home sustaining a hip fracture, which requires surgery. He is admitted on a Sunday, scheduled for surgery on Monday. The pre-op work up included a chest x-ray. The results CXR Impression: Lungs: Increase in size of moderate to large right effusion with right to mid lower lung zone opacity which may represent possible atelectasis, pneumonia, or consolidation. Cultures were not taken. What is the correct response for the pre op pneumonia?
a- No
b- Yes
a- No
Does not meet criteria 1 (rales and sputum, blood culture, or specimen biopsy) nor does it meet criterion 2 (CXR showing consolidation AND sputum, blood culture, specimen biopsy, viral antigen isolation, or histopathologic evidence).
On the Histogram Plot in the NSO Quarterly Report, if the facility orange triangle is to the RIGHT of the national red triangle, it means that the facility mean mortality risk is _______the national mean mortality risk for the same invasive procedure complexity level:
a- Equal to
b- Higher than
c- Less than
b- Higher than
National mean of same operative complexity is red. Facility mean is orange
Veteran underwent a Nissen procedure. On POD 3, veteran returned to surgery for a slipped Nissen. Decision made to return to OR for takedown of Nissen fundoplication, reduction of paraesophageal hernia and gastropexy. Note that mesh was not used during the hernia repair. How should the SQN capture for the Graft/Prosthesis/Flap Failure variable?
a- No
b- Yes
a- No
It would not be a graft/prosthesis/flap failure for the failed Nissen fundoplication because wrapping the stomach is not a graft, flap, or an implant. A failed fundoplication could be compared to an anastomotic leak. Note, if mesh had been used during the hernia repair portion and that was manipulated during the return to surgery, then this would meet the failed graft definition.
A patient has a shoulder replacement. On post-op day 25 his pain increases in his shoulder. The shoulder is tapped at the bedside and the gram stain has many WBCs. The patient is placed on antibiotics for a wound infection. What is the correct response for graft/prosthesis/flap failure?
a- No
b- Yes
a- No
Procedure was performed at bedside and not in OR or IR, so does not meet definition
Patient visited his primary care provider (PCP) 14 days prior to surgery. Nursing note states patient complained of chest discomfort while in the waiting room to see his PCP. There was no mention of an assessment of pain/discomfort or its treatment in his PCP’s note. Which is correct response for angina timeframe variable?
a- No Angina
b- Within 14 Days Prior to Surgery
c- Within 15 - 30 Days Prior to Surgery
a- No Angina
Chest pain must be due to angina. No documentation to support angina.
A patient’s nursing admit note indicates that fifteen days before the patient had his hip surgery he started using a walker to get around; he is unable to bathe himself. What is the correct response for the functional health status variable?
a- Independent
b- Partially dependent
c- Totally dependent
a- Independent
Patient is able to use walker without assistance - independent mobility; unable to bathe himself - dependent bathing; rest of ADL's not mentioned - therefore based on this information - independent as only has 1 dependent ADL - bathing