Surgeon
*
MRN
*
Gender
*
Date of birth
MM
DD
YYYY
Date of admission
*
MM
DD
YYYY
Grade of complication
As per RACS standards
Complication type
*
Did the complication lead to readmission?
*
Did the patient return to theatre?
*
Was there an unplanned admission to ICU or HDU?
*
Did the complication lead to death?
*
Was there an issue with access to theatre or timing of surgery?
*
VTE prophylaxis used
*
Provide a brief description of the complication
In hindsight, could management have been improved in any of the following areas?
Any other comments
