Assessing the adherence of operative notes for laparoscopic appendectomy with the royal college of surgeons guidelines

Fatima Mannan, Roger Christopher Gill, Abdul Ahad Sohail, Rehman Alvi

Research output: Contribution to journalReview articlepeer-review


Objective: To determine the frequency of adherence of laparoscopic appendectomy operative notes with the Royal College of Surgeons (RCS) guidelines at the tertiary care centre. Study Design: A clinical audit report. Place and Duration of Study: The Aga Khan University Hospital, Karachi between January and June 2018. Methodology: Operative notes of laparoscopic appendectomy, written by residents of general surgery from trainee levels R1 to R5 during the study period, were included in the study. Each component from RCS guidelines, was assessed. The response to every question in proforma was marked either as Y=Yes or N=No. Overall score of more than 70% was chosen arbitrarily as a qualifying standard for an adequate operative note. Data were analysed by using SPSS (version 21). A p-value of <0.05 was considered significant. Results: A total of 74 operative notes relating to laparoscopic appendectomy were reviewed during the study period. Most of these, i.e. 46% notes, were written by year one residents; 47.1% operative notes showed adequacy of practice in concordance with RCS guidelines. The most lacking component in operative notes was mentioning of the operative time, port sites, intraoperative complications and details of specimen removed. Stratified analysis of operative notes did not reveal any association between age, gender and level of training of residents to affect the adequacy of operative note documentation. Conclusion: Only a quarter of the studied documentation fulfilled the criteria for adequacy of practice. Residents need to be educated and familiarised with these guidelines to improve documentation of operative procedures. Strategies need to be formulated and tested to improve the performance.

Original languageEnglish
Pages (from-to)202-205
Number of pages4
JournalJournal of the College of Physicians and Surgeons--Pakistan : JCPSP
Issue number2
Publication statusPublished - Feb 2021


  • Acute appendicitis
  • Good medical practice
  • Laparoscopic appendectomy
  • Operative notes
  • RCS guidelines


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