Research Article| Volume 36, SUPPLEMENT 1, S44-S49, September 2010

Download started.


Synoptic operative record for point of care outcomes: A leap forward in knowledge translation



      Modern information technology coupled with synoptic methodology allows point of care, real time outcomes generation. Our objective was to review province-wide breast cancer surgery outcomes from a prospective synoptic operative record to demonstrate its value in knowledge translation.


      All synoptic reports for breast cancer procedures from 2006 until March 2010 were reviewed and descriptively analyzed. Key outcomes included frequency of breast cancer procedures captured over time, methods of breast cancer detection, clinical staging, method of axillary staging, breast conservation and reconstruction rates. Further analysis involved important decision-making for mastectomy and resource allocation for surgery.


      Four thousand nine hundred fifty-five breast cancer procedures were recorded synoptically; greater than 80% of cases provincially. Method of breast cancer detection was 49%, 45% and 4% by screening radiology, patient or family, and physician, respectively. Pathologic diagnoses were via core or mammotome biopsy in 94%; nearly half of all patients were clinical Stage I at time of operation. Overall rate of breast conservation was 48%. Of the 65% who had no contra-indication to breast conservation surgery, 76% had breast conservation and 4% had primary reconstruction. Of those having mastectomy, one third were due to patient choice. Seventy-nine percent had sentinel node staging, 18% had full axillary dissection and 3% had no axillary staging.


      A new paradigm of creating medical records using synoptic electronic templates allows prospective outcomes generation at point of care by the surgeon which is unparalleled in its depth of surgical detail capturing surgical decision-making.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to European Journal of Surgical Oncology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Mack L.A.
        • Bathe O.F.
        • Hebert M.A.
        • et al.
        Opening the black box of cancer surgery quality: WebSMR and the Alberta experience.
        J Surg Oncol. 2009; 99: 525-530
        • Elevitch F.R.
        SNOMED CT: electronic health record enhances anesthesia patient safety.
        AANA J. 2005; 73: 361-366
        • Cruz-Correia F.J.
        • Viera-Marquies P.M.
        • Ferreira A.M.
        • et al.
        Reviewing the integration of patient data: how systems are evolving in practice to meet patient needs.
        BMC Med Inform Decis Mak. 2007; 7: 14
        • Edhemovic I.
        • Temple W.J.
        • de Gara C.J.
        • et al.
        The computer synoptic operative report – a leap forward in the science of surgery.
        Ann Surg Oncol. 2004; 11: 941-947
        • Lefter L.P.
        • Walker S.R.
        • Dewhurst F.
        • et al.
        An audit of operative notes: facts and ways to improve.
        ANZ J Surg. 2008; 78: 800-802
        • Nicopoullos J.D.
        • Karrar S.
        • Gour A.
        • et al.
        Significant improvement in quality of caesarean section documentation with dedicated operative proforma–completion of the audit cycle.
        J Obstet Gynaecol. 2003; 23: 381-386
        • Shayah A.
        • Agada F.O.
        • Gunasekaran S.
        • et al.
        The quality of operative note taking: an audit using the Royal College of Surgeons Guidelines as the gold standard.
        Int J Clin Pract. 2007; 61: 677-679
        • Harvey A.
        • Zhang H.
        • Nixon J.
        • et al.
        Comparison of data extraction from standardized versus traditional narrative operative reports for database-related research and quality control.
        Surgery. 2007; 114: 708-714
        • Cowan D.A.
        • Sands M.B.
        • Rabizadeh S.M.
        • et al.
        Electronic templates versus dictation for the completion of Mohs micrographic surgery operative notes.
        Dermatol Surg. 2007; 33: 588-595
        • Cross S.S.
        • Feeley K.M.
        • Angel C.A.
        The effect of four interventions on the informational content of histopathology reports of resected colorectal carcinomas.
        J Clin Pathol. 1998; 51: 481-482
        • Rigby K.
        • Brown S.R.
        • Lakin G.
        • et al.
        The use of a proforma improves colorectal cancer pathology reporting.
        Ann R Coll Surg Engl. 1999; 81: 401-403
        • Karim R.Z.
        • van den Berg K.S.
        • Colman M.H.
        • et al.
        The advantage of using a synoptic pathology report format for cutaneous melanoma.
        Histopathology. 2008; 52: 130-138
        • Delaney G.
        • Shafiq J.
        • Chappell G.
        • et al.
        Establishing treatment benchmarks for mammography-screened breast cancer population based on a review of evidence-based guidelines.
        Cancer. 2008; 112: 1912-1922
        • Rickard M.T.
        • Taylor R.J.
        • Fazli M.A.
        • et al.
        Interval breast cancers in an Australian mammographic screening program.
        Med J Aust. 1998; 169: 184-187
        • Hershman D.L.
        • Buono D.
        • Jacobson J.S.
        • et al.
        Surgeon characteristics and use of breast conservation surgery in women with early stage breast cancer.
        Ann Surg. 2009; 249: 828-833
        • Lazovich D.
        • Solomon C.C.
        • Thomas D.B.
        • et al.
        Breast conservation therapy in the United States following the 1990 National Institutes of Heath Consensus Development Conference on the treatment of patients with early stage invasive breast carcinoma.
        Cancer. 1999; 86: 628-637
        • McGuire K.P.
        • Santillan A.A.
        • Kaur P.
        • et al.
        Are mastectomies on the rise? A 13-year trend analysis of the selection of mastectomy versus breast conservation therapy in 5865 patients.
        Ann Surg Oncol. 2009; 16: 2682-2690
        • Weiser T.G.
        • Haynes A.B.
        • Dziekan G.
        • et al.
        Effect of a 19-item surgical safety checklist during urgent operations in a global patient population.
        Ann Surg. 2010; 251: 976-980
        • Rodriguez J.F.
        • Trobo A.R.
        • Garcia M.V.
        • et al.
        The effect of performance feedback on wound infection rate in abdominal hysterectomy.
        Am J Infect Control. 2006; 34: 182-187
        • Rowell K.S.
        • Turrentine F.E.
        • Hutter M.M.
        • et al.
        Use of national surgical quality improved program data as a catalyst for quality improvement.
        J Am Coll Surg. 2007; 204: 1293-1300
        • Hall B.L.
        • Hamilton B.H.
        • Richards K.
        • et al.
        Does surgical quality improve in the American College of surgeons national surgical quality improvement program: an evaluation of all participating hospitals.
        Ann Surg. 2009; 250: 363-376
        • Temple W.J.
        • Francis W.P.
        • Tamano E.
        • et al.
        Synoptic surgical reporting for breast cancer surgery: an innovation in knowledge translation.
        Am J Surg. 2010 Feb 15;