RICHIESTA ESTRAZIONE DATI

(1)

Fondatore e Presidente Onorario R. Crisci (L’Aquila-Teramo)

Responsabile Scientifico C. Curcio (Napoli)

Coordinatori Scientifici D. Amore (Napoli) A. Bertani (Palermo) A. Gonfiotti (Firenze)

Referenti di Area Nord Italia A. Morelli (Udine)

Centro Italia L. Voltolini (Firenze)

Sud Italia M. Taurchini (S. G. Rotondo)

Referente Biostatistico L. Bertolaccini (Ravenna)

Referente Progetto ERAS A. Droghetti (Mantova)

Comitato Scientifico S. Nicotra (Padova)

D. Tosi (Milano) A. Rinaldo (Milano) C. Andreetti (Roma) P. Camplese (Chieti) L. Andriolo (Lecce) D. Divisi (Teramo) F. P. Caronia (Palermo)

Comitato di Accesso A. Morelli (Udine) L. Voltolini (Firenze) M. Taurchini (S. G. Rotondo)

RICHIESTA ESTRAZIONE DATI

Il/la sottoscritto/a (cognome e nome)

___________________________________________________________________

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e-mail _____________________________________________________________

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città _______________________________________________________________

direttore ___________________________________________________________

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(2)

Admission ( tutti i campi) Structure ID Admission date

Hospital records number Gender

Patient code

Age at surgical procedure date Type

Validation date Experience number Eras drop out

Eras drop out cause: Physiotherapy management - Early postoperative physiotherapy = NONE

Eras drop out cause: Physiotherapy management - Preoperative assessment = NO Eras drop out cause: Physiotherapy management - Preoperative conditioning = NO Eras drop out cause: Anaesthesia - Cardiovascular reserve (METs) evaluation ≥ 4 = NO Eras drop out cause: Anaesthesia - Haemodynamic optimization = NO

Eras drop out cause: Anaesthesia - PONV prevention strategy = NO Eras drop out cause: Anaesthesia - Protective ventilation strategy = NO Eras drop out cause: Anaesthesia - Strategies for maintaining euthermia = NO

Eras drop out cause: Anaesthesia - Titration of NMBA and reversal with NMT monitor = NO Eras drop out cause: Anaesthesia - Use of short-acting drugs = NO

Eras drop out cause: Surgical procedure - Chest tubes > 1

Eras drop out cause: Surgical procedure - Intraoperative air leak without haemostasis and tissue sealing used

Eras drop out cause: Analgesia - Locoregional analgesic (LRA) technique used = NO Eras drop out cause: Analgesia - Scheduled pain evaluation with NRS (Every 15 minutes

until stabilization; then at least every change shift) = NO

Eras drop out cause: Analgesia - Systemic analgesic adjuvants at scheduled administration

= NO

Eras drop out cause: Discharge - Dischage day measurement of pain ≥ 4 Eras drop out cause: Discharge - Discharge not done

Eras drop out cause: Discharge - Drain removal if effusion <3 mL/kg = NO Eras drop out cause: Follow-up - Re-admission required

Pre operative PHE ( tutti i campi) Structure ID

Question nr 1 Question nr 2 Question nr 3 Question nr 4 Question nr 5 PHE score

Oncological history ( tutti i campi) Structure ID

Result Pathology Pathology spec.

Surgery Chemiotherapy Radiotherapy

(3)

Comorbidities ( tutti i campi) Structure ID

Smoker

Smoker: Cessation date Smoker: Cigarettes per day Smoker: Years

Smoker: PY

Myocardial infarction Congestive heart failure Peripheral vascular disease Cerebrovascular disease Dementia

COPD

Connective tissue disease Peptic ulcer disease Diabetes mellitus

Moderate to severe chronic kidney disease Hemiplegia

Leukemia

Malignant lymphoma Solid tumor

Liver disease AIDS Scoring: Age Final score

ECOG ( tutti i campi) Structure ID ECOG score

Pulmonary function evaluation ( tutti i campi) Structure ID

BMI: Height (cm) BMI: Weight (kg) BMI: value Spirometry: Done Spirometry: FEV1 value Spirometry: FEV1 % Spirometry: FVC value Spirometry: FVC % Spirometry: Tiffenau Spirometry: DLCO/VA % Hemogasanalysis: Done Hemogasanalysis: O2 Hemogasanalysis: CO2 Hemogasanalysis: pH 6 minutes walking test: Done 6 minutes walking test: Meters 6 minutes walking test: SatO2 (min) 6 minutes walking test: SatO2 (max) 6 minutes walking test: Final SatO2 % 6 minutes walking test: HR

Cardiac stress: Done

(4)

Cardiac stress: ml/kg/min Cardiac stress: VO2 max test Lung scintigrafy: Done Lung scintigrafy: Right % Lung scintigrafy: Left % Lung scintigrafy: ppoFEV1 value Lung scintigrafy: ppoFEV1 % Lung scintigrafy: pppDLCO value Lung scintigrafy: pppDLCO %

Thorax ct scan ( tutti i campi) Structure ID

Done T: Value T: Size T: Lung T: Lobe T: Type N

Station: N1 10 Station: N1 11 Station: N1 12-13-14 Station: N2 1 Station: N2 2 Station: N2 3 Station: N2 4 Station: N2 5 Station: N2 6 Station: N2 7 Station: N2 8 Station: N2 9

Station: N3 Contralateral Station: N3 Supraclavicular Station: N3 Other

M

M: Pleural Effusion (citologically proven) M: Controlateral Lung

M: Thorax M: Brain M: Bone

M: Extra-thoracic nodes M: Kidney

M: Adrenal gland M: Bowel M: Liver M: Other

TNM Stage (8th ed.) TNM Stage (7th ed.) Ground Glass Opacity

(5)

PET ( tutti i campi) Structure ID Done T: Value T: Size T: Lung T: Lobe T: SUV N

Station: N1 10 Station: N1 11 Station: N1 12-13-14 Station: N2 1 Station: N2 2 Station: N2 3 Station: N2 4 Station: N2 5 Station: N2 6 Station: N2 7 Station: N2 8 Station: N2 9

Station: N3 Contralateral Station: N3 Supraclavicular Station: N3 Other

M

TNM Stage (8th ed.) TNM Stage (7th ed.)

Preoperative diagnosis ( tutti i campi) Structure ID

Done

Bronchoscopy: Done Bronchoscopy: Result FNAB: Done

FNAB: Result

Mediastinoscopy: Done Mediastinoscopy: Result EBUS: Done

EBUS: Result EUS: Done EUS: Result

(6)

Neoadiuvant treatments ( tutti i campi) Structure ID

Done

Chemotherapy Radiotherapy

Perioperative management and nutritional support ( tutti i campi) Structure ID

Anemia: At first examination Anemia: Correction Anemia: At operation Malnutrition: Present Malnutrition: Correction Preoperative fasting

Postoperative nutrition resume Liquids balance

Postoperative mobilization

Physiotherapy management ( tutti i campi) Structure ID

Preoperative assessment Preoperative conditioning

Respiratory PT devices: Coach/Voldyne Respiratory PT devices: Triflo

Respiratory PT devices: Acapella/Therapep Early postoperative physiotherapy Number of motor PT sessions Number of respiratory PT sessions

Motor PT exercises: Passive and active aimbs mobilization Motor PT exercises: Bed postural exercises

Motor PT exercises: Posture variation exercises Motor PT exercises: Stepping verticalization exercises Motor PT exercises: Bike

Motor PT exercises: Progressive walking reconditioning Respiratory PT Exercises: Breathing control

Respiratory PT Exercises: Thoracic expansion exercise Respiratory PT Exercises: Forced expiration technique Respiratory PT Exercises: Active cycle of breathing techniques Respiratory PT Exercises: Postural drainage

Respiratory PT Exercises: Huffing

Respiratory PT Exercises: Coughing assisted Physiotherapy service discharge day

Anaesthesia ( tutti i campi) Structure ID

Cardiovascular reserve (METs) evaluation ≥ 4 Use of short-acting drugs

Haemodynamic optimization

Titration of NMBA and reversal with NMT monitor (use of reversal mandatory if NMT monitor not avaiable)

Protective ventilation strategy (in TLV and OLV)

Strategies for maintaining euthermia (Body temperature at extubation ≥ 36 °C) PONV prevention strategy (in Pts with Apfel Scale ≥ 2)

(7)

Surgical procedure ( tutti i campi) Structure ID

Date

Seniority (years from the end of the residency) First operator experience in VATS lobectomy Surgical technique

Number of incisions apart from utility thoracotomy Number of trocars

Length utility thoracotomy (cm) Degree thoracoscope

Length thoracoscope (mm)

Operative time (skin to skin in minutes) Side

Type of resection En bloc

Fissureless lobectomy Lymph node dissection: Done Lymph node dissection: Type Lymph node dissection: Tecnique

Lymph node dissection: Tecnique manufacturer Lymph node dissection: Tecnique model Number of resected lymph nodes: N1 10 Number of resected lymph nodes: N1 11 Number of resected lymph nodes: N1 12-13-14 Number of resected lymph nodes: N2 1 Number of resected lymph nodes: N2 2 Number of resected lymph nodes: N2 3 Number of resected lymph nodes: N2 4 Number of resected lymph nodes: N2 5 Number of resected lymph nodes: N2 6 Number of resected lymph nodes: N2 7 Number of resected lymph nodes: N2 8 Number of resected lymph nodes: N2 9

Number of resected lymph nodes: N3 Contralateral Number of resected lymph nodes: N3 Supraclavicular Number of resected lymph nodes: N3 Other

Number of N1 resected lymph nodes Number of N2 resected lymph nodes Number of N3 resected lymph nodes Total resected lymph nodes Preoperative histology Conversion

Conversion cause: Bleeding Conversion cause: Adhesions

Conversion cause: Incomplete or difficult fissure Conversion cause: Calcified lymphnode on pulm artery Conversion cause: Tumor crossing fissure

Conversion cause: Time limit

Conversion cause: Chest wall invasion (T3 tumor) Conversion cause: Advanced staging

Conversion cause: Wrong position of incisions Conversion cause: Difficult localization of tumor/lesion Conversion cause: Anatomical anomalies

(8)

Conversion cause: Transition to pneumonectomy Conversion cause: Other

Venous techniques Arterial suture techniques Bronchial techniques

Fissures completion techniques Blood loss

Adhesiolysis

Soft tissue retractors: Used Soft tissue retractors: Model Number of chest tubes used Chest tube 1: FR./CH.

Chest tube 1: Under water seal drain Chest tube 1: Aspiration

Chest tube 1: Aspiration duration Chest tube 2: FR./CH.

Chest tube 2: Under water seal drain Chest tube 2: Aspiration

Chest tube 2: Aspiration duration Pain relief techniques: Intercostal block Pain relief techniques: Pericostal cathethers Pain relief techniques: Peridural cathethers Pain relief techniques: Elastomeric pump ev Pain relief techniques: PEC block 1

Pain relief techniques: PEC block 2 Pain relief techniques: Serratus Plane Block Pain relief techniques: Other

Pain relief techniques: Other techniques used Intraoperative air leak

Haemostasis and tissue sealing: Used

Haemostasis and tissue sealing product: Coseal Haemostasis and tissue sealing product: Emopatch Haemostasis and tissue sealing product: Evicel Haemostasis and tissue sealing product: Progel Haemostasis and tissue sealing product: Surgicel Haemostasis and tissue sealing product: Surgiflo Haemostasis and tissue sealing product: Tachosil Haemostasis and tissue sealing product: Tisseel Haemostasis and tissue sealing product: Other

Surg. proc. tec. - Venous ( tutti i campi) Structure ID

Technique Manufacturer Model Reloads

Surg. proc. tec. - Arterial ( tutti i campi) Structure ID

(9)

Surg. proc. tec. - Bronchial ( tutti i campi) Structure ID

Surg. proc. tec. - Fiss. comp. ( tutti i campi) Structure ID

Analgesia ( tutti i campi) Structure ID

Scheduled pain evaluation with NRS (Every 15 minutes until stabilization; then at least every change shift)

Locoregional analgesic (LRA) technique: Used Locoregional analgesic (LRA) technique type: PVB Locoregional analgesic (LRA) technique type: SAPB Locoregional analgesic (LRA) technique type: ICNB Locoregional analgesic (LRA) technique type: Wound Locoregional analgesic (LRA) technique type: Other

Locoregional analgesic (LRA) technique: Single shot or infusion Locoregional analgesic (LRA) technique: Timing

2nd locoregional analgesic (LRA) technique: Used 2nd locoregional analgesic (LRA) technique type: PVB 2nd locoregional analgesic (LRA) technique type: SAPB 2nd locoregional analgesic (LRA) technique type: ICNB 2nd locoregional analgesic (LRA) technique type: Wound 2nd locoregional analgesic (LRA) technique type: Other

2nd locoregional analgesic (LRA) technique: Single shot or infusion 2nd locoregional analgesic (LRA) technique: Timing

Postoperative systemic opioids: Used

Postoperative systemic opioids: Parenteral major opioids administration until POD1 Postoperative systemic opioids ORAE: Nausea or vomit

Postoperative systemic opioids ORAE: Excessive sedation Postoperative systemic opioids ORAE: Constipation Postoperative systemic opioids ORAE: Bradypnea Postoperative systemic opioids ORAE: Hypotension Postoperative systemic opioids ORAE: Urinary retention

Postoperative systemic opioids: Systemic analgesic adjuvants at scheduled administration Postoperative systemic opioids: Evaluation of pain in follow-up interviews

(10)

Final pathology report ( tutti i campi) Structure ID

Result Pathology Pathology spec.

T: Value T: Size T: Lung T: Lobe T: Type N: Value

Number of positive lymph nodes: N1 10 Number of positive lymph nodes: N1 11 Number of positive lymph nodes: N1 12-13-14 Number of positive lymph nodes: N2 1 Number of positive lymph nodes: N2 2 Number of positive lymph nodes: N2 3 Number of positive lymph nodes: N2 4 Number of positive lymph nodes: N2 5 Number of positive lymph nodes: N2 6 Number of positive lymph nodes: N2 7 Number of positive lymph nodes: N2 8 Number of positive lymph nodes: N2 9

Number of positive lymph nodes: N3 Contralateral Number of positive lymph nodes: N3 Supraclavicular Number of positive lymph nodes: N3 Other

Number of N1 positive lymph nodes Number of N2 positive lymph nodes Number of N3 positive lymph nodes Total positive lymph nodes

Lymph nodes type: Micrometastasis Lymph nodes type: Intracapsular Lymph nodes type: Extracapsular M: Value

TNM Stage (8th ed.) TNM Stage (7th ed.) Grading

Radical dissection

(11)

Postoperative complications ( tutti i campi) Structure ID

Cardiovascular: Atrial fibrillation and minor dysrhythmia Cardiovascular: Myocardial ischemia and infarction (MI) Cardiovascular: TIA, stroke, ictus

Acute cardiovascular: Acute peripheral arterial tromoembolism Acute cardiovascular: Cardiac arrest

Pulmonary: Prolonged air leak (>7days) Pulmonary: Pulmonary embolism Pulmonary: ARDS

Pulmonary: Persistent pleural space (on ChestXrays) Pulmonary: Pneumonia, pleural effusion, empyema Pulmonary: Re-intubation, mechanical ventilaton Pulmonary: Middle lobe torsion

Pulmonary: Atelectasis Pulmonary: Sputum retention Surgical: Hemothorax

Surgical: Bronchopleural fistula Surgical: Chylothorax

Surgical: Phrenic nerve injurypalsy

Surgical: Recurrent laryngeal nerve palsydysphonia Surgical: Blood transfusion

Renal: Acute renal failure Renal: Urinary tract infection Renal: Need dialysis

Gastrointestinal: Antibiotic dysenterydiarrhea Gastrointestinal: Pancreatitis

Gastrointestinal: Intestinal infarction

Gastrointestinal: Acute abdomenowel obstruction Major: Need prolonged mechanical ventilation Major: Need postoperative ICU

Adiuvant treatments ( tutti i campi) Structure ID

Done

Chemotherapy Radiotherapy

Discharge ( tutti i campi) Structure ID

Ninety-Day Mortality Risk Score (Brunelli Score): Score Ninety-Day Mortality Risk Score (Brunelli Score): Class of risk Ninety-Day Mortality Risk Score (Brunelli Score): 90-Day Mortality, % Done

Not done: Cause

Discharge date/Admission end date PHE: Question nr 1

PHE: PHE Question nr 2 PHE: PHE Question nr 3 PHE: PHE Question nr 4 PHE: Question nr 5 PHE: Score

Measurement of pain: Day 1

(12)

Measurement of pain: Day 2 Measurement of pain: Day 3 Measurement of pain: Discharge day Chest tube 1: Total days

Chest tube 1: Drain removal if effusion <3 mL/kg Chest tube 1: Total chest drain duration Chest tube 1: Total air leak duration Chest tube 1: I day - ml

Chest tube 1: I day - Air leak Chest tube 1: II day - ml Chest tube 1: II day - Air leak Chest tube 1: III day - ml Chest tube 1: III day - Air leak Chest tube 1: IV day - ml Chest tube 1: IV day - Air leak Chest tube 1: V day - ml Chest tube 1: V day - Air leak Chest tube 1: VI day - ml Chest tube 1: VI day - Air leak Chest tube 1: Last day - ml Chest tube 1: Last day - Air leak Chest tube 2: Total days

Chest tube 2: Drain removal if effusion <3 mL/kg Chest tube 2: Total chest drain duration Chest tube 2: Total air leak duration Chest tube 2: I day - ml

Chest tube 2: I day - Air leak Chest tube 2: II day - ml Chest tube 2: II day - Air leak Chest tube 2: III day - ml Chest tube 2: III day - Air leak Chest tube 2: IV day - ml Chest tube 2: IV day - Air leak Chest tube 2: V day - ml Chest tube 2: V day - Air leak Chest tube 2: VI day - ml Chest tube 2: VI day - Air leak Chest tube 2: Last day - ml Chest tube 2: Last day - Air leak EuroQol-5D: Mobility

EuroQol-5D: Self-care EuroQol-5D: Usual activities EuroQol-5D: Pain/Discomfort EuroQol-5D: Anxiety/Depression EuroQol-5D: Patient health state EuroQol-5D: Final value EuroQol-5D: Score

(13)

First follow-up ( tutti i campi) Structure ID

Patient

Present: Follow-up date

Present: Follow-up date is not standard Present: Follow-up date is not standard - Cause Present: Follow-up date is not standard - Cause spec.

Present: Status Present: Relapse Present: Relapse - Date

Present: Relapse - Site and pattern - Lung Present: Relapse - Site and pattern - Mediastinum Present: Relapse - Site and pattern - Lymph nodes Present: Relapse - Site and pattern - Liver Present: Relapse - Site and pattern - Brain Present: Relapse - Site and pattern - Skin Present: Relapse - Site and pattern - Bone Present: Relapse - Site and pattern - Other site Present: Relapse - Therapy

Present: Relapse - Status after treatment Present: PHE - Question nr 1

Present: PHE - Question nr 2 Present: PHE - Question nr 3 Present: PHE - Question nr 4 Present: PHE - Question nr 5 Present: PHE - Score

Present: Measurement of pain Present: Re-admission - Required

Present: Re-admission - Cause - Atrial fibrillation Present: Re-admission - Cause - Bronchial fistula Present: Re-admission - Cause - Dyspnea Present: Re-admission - Cause - Empyema Present: Re-admission - Cause - Fever Present: Re-admission - Cause - Hemothorax Present: Re-admission - Cause - Pain

Present: Re-admission - Cause - Pleural effusion Present: Re-admission - Cause - Pneumonia Present: Re-admission - Cause - Pneumothorax Present: Re-admission - Cause - Skin incision dehiscence Present: Re-admission - Cause - Wound infection Present: EuroQol-5D - Mobility

Present: EuroQol-5D - Self-care Present: EuroQol-5D - Usual activities Present: EuroQol-5D - Pain/Discomfort Present: EuroQol-5D - Anxiety/Depression Present: EuroQol-5D - Patient health state Present: EuroQol-5D - Final value Present: EuroQol-5D - Score

Present: Patient information and education - 1st day objectives reached Present: Patient information and education - 2nd day objectives reached Present: Patient information and education - 3rd day objectives reached

Present: Patient information and education - Patient involved with the decisions about his/her care

(14)

Present: Patient information and education - Patient found daily diary useful Dead: Death date

Dead: Status

Dead: Death related to cancer

Dead: Death not related to cancer - Cause Missed follow-up: Patient lost to follow-up

Last follow-up ( tutti i campi) Structure ID

Patient

Present: Re-admission - Cause - Pleural effusion Present: Re-admission - Cause - Pneumonia Present: Re-admission - Cause - Pneumothorax Present: Re-admission - Cause - Skin incision dehiscence Present: Re-admission - Cause - Wound infection Present: EuroQol-5D - Mobility

Present: EuroQol-5D - Self-care Present: EuroQol-5D - Usual activities Present: EuroQol-5D - Pain/Discomfort Present: EuroQol-5D - Anxiety/Depression Present: EuroQol-5D - Patient health state

(15)

Present: EuroQol-5D - Final value Present: EuroQol-5D - Score

Dead: Status

All follow-ups ( tutti i campi) Structure ID Patient

Present: Re-admission - Cause - Pleural effusion Present: Re-admission - Cause - Pneumonia Present: Re-admission - Cause - Pneumothorax Present: Re-admission - Cause - Skin incision dehiscence

(16)

Present: Re-admission - Cause - Wound infection Present: EuroQol-5D - Mobility

Present: EuroQol-5D - Self-care Present: EuroQol-5D - Usual activities Present: EuroQol-5D - Pain/Discomfort Present: EuroQol-5D - Anxiety/Depression Present: EuroQol-5D - Patient health state Present: EuroQol-5D - Final value Present: EuroQol-5D - Score

Dead: Status

RICHIESTA ESTRAZIONE DATI

RICHIESTA ESTRAZIONE DATI

Il/la sottoscritto/a (cognome e nome)

___________________________________________________________________

tel. ___ fax _

e-mail _____________________________________________________________

in qualità di referente del Centro Accreditato

struttura ___________________________________________________________

città _______________________________________________________________

direttore ___________________________________________________________

**Richiede l’estrazione dei seguenti dati dal Database dei seguenti campi*:**

I dati richiesti sono riferiti Alla mia struttura A tutto il database

*NB: riportare esattamente il nome indicato nel Database; per estrazione dati si

intende la semplice estrapolazione, senza alcuna elaborazione.

In fede

Data e firma

Inviare la presente richiesta

via e-mail all’indirizzo vatsgroupinfo@gmail.com

RICHIESTA ESTRAZIONE DATI

RICHIESTA ESTRAZIONE DATI

Il/la sottoscritto/a (cognome e nome)

___________________________________________________________________

tel. _______________________________ fax _____________________________

e-mail _____________________________________________________________

in qualità di referente del Centro Accreditato

struttura ___________________________________________________________

città _______________________________________________________________

direttore ___________________________________________________________

Richiede l’estrazione dei seguenti dati dal Database dei seguenti campi*:

I dati richiesti sono riferiti Alla mia struttura A tutto il database

*NB: riportare esattamente il nome indicato nel Database; per estrazione dati si

intende la semplice estrapolazione, senza alcuna elaborazione.

In fede

Data e firma

Inviare la presente richiesta

via e-mail all’indirizzo vatsgroupinfo@gmail.com

tel. ___ fax _

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