Clinical Audit of Preoperative Preparation in Oral Cancer Surgery as per NCCN Guidelines

Clinical Audit of Preoperative Preparation in Oral Cancer Surgery as per NCCN Guidelines

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  Clinical Audit ofPreoperative Preparation in Oral Cancer Surgery as per NCCN Guidelines SHRI BALAJI METRO HOSPITAL Dr Yash Chaddha MDS,FHNO,IFHNOS
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  Educational Qualification • BDS,from MCODS , Manipal (2007-2012) • MDS from RGUHS,Bangalore(2014-17) • Fellowship in Head and Neck Trauma – Elite Mission Hospital – Thrisshur (Kerela)(2017-18) • FHNO (Fellowship in Head and Neck Oncology) –BLK Max Hospital, New Delhi (2019-21) • IFHNOS - GOLF (Fellowship in Head and Neck Oncology) – MSKCC(Memorial sloan kettering cancer centre), New York (2019-21) • Fellowship in Robotic Head and Neck Surgey - BLK Max Hospital, New Delhi (2021-22) • Work Experience • Associate consultant NHMMI Hospital Raipur 2022-24 • Consultant Shri Balaji Metro Hospital 2024 - Current
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  Introduction • NCCN preoperativeguidelines ensure standardized evaluation and preparation for oral cancer surgery. • Key steps include: clinical examination, imaging, nutrition, dental, airway, and multidisciplinary assessment. • Adherence minimizes perioperative risk, improves postoperative recovery, and enhances long-term outcomes.
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  Aim • To measurethe level of compliance with NCCN preoperative care guidelines among oral cancer patients treated at Shri Balaji Metro Hospital, Raigarh.
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  Methodology • Type: Analyticalclinical audit (Retrospective) • Duration: 15th April – 15th October 2025 (6 months) • Sample Size: 25 patients • Data Source: Medical Records Department (MRD) • Assessment Tool: Audit checklist based on NCCN guidelines • Audit Team: Consultant, Quality Manager, Nursing Superintendent, Medical Officer
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  Audit checklist Sl.No CriteriaStandard (% compliance) Definitions and instructions for data collection 1 History and physical Examination 100% All Oral Cancer Patients 2 Head and Neck Examination (including – fibreoptic exam) 100% 40% All Oral Cancer Patients 3 Biopsy 100% All Oral Cancer Patients 4 CT/MRI with Contrast of Primary site and Neck 100% All Oral Cancer Patients
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  Audit checklist Sl.No CriteriaStandard (% compliance) Definitions and instructions for data collection 4 CT chest (with / without contrast) 100% All Oral Cancer Patients 5 Head and Neck Examination (including – fibreoptic exam) 100% All Oral Cancer Patients 6 FDG PET –(Consider) 20% All Oral Cancer Patients 7 Dental / Prosthodontic evaluation with Panorex 80% All Oral Cancer Patients
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  Audit checklist Sl.No CriteriaStandard (% compliance) Definitions and instructions for data collection 9 Nutrition, speech, swallowing Evaluation 100% All Oral Cancer Patients 10 Tobacco Cessation Counselling 100% All Oral Cancer Patients 11 Screening for Hepatitis -B 100% All Oral Cancer Patients 12 PDL-1 Testing (CPS – Combined positive score) 0% All Oral Cancer Patients
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  Audit checklist Sl.No CriteriaStandard (% compliance) Definitions and instructions for data collection 13 Pre-Anesthesia Evaluation 100% All Oral Cancer Patients 14 Multidisciplinary Consultation (as clinically )indicated 100% All Oral Cancer Patients
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  Results: Compliance Chart
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  Discussion • Complete Headand Neck Examination done in all patients • Fibreoptic examination done only in suspicious or clinically indicated cases or who had reduced mouth opening to assess the airway status • Biopsy and imaging with contrast CT done in all patients • FDG PET/CT – clinically indicated (advanced T4b,N3b) • Panorex (OPG) – done in indicated cases • PDL-1 (CPS)testing – not done
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  Discussion • Overall complianceto NCCN preoperative guidelines was high (average 83%) • Full compliance achieved in core areas: examination, biopsy, imaging, and pre anesthesia evaluation. • Partial compliance noted in dental evaluation (80%) and PET-CT (20%) • PDL-1 testing not performed in any patient (0%) • Improved documentation and multidisciplinary coordination can enhance compliance further.
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  Improvement 1. Develop astructured preoperative checklist in MRD based on NCCN guidelines 2. Ensure early involvement of nutrition and dental teams. 3. Incorporate routine PET-CT and PDL-1 testing where indicated 4. Conduct staff training sessions to reinforce protocol adherence
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  Conclusion • High compliancewith NCCN preoperative guidelines achieved in majority of oral cancer cases. • Identified gaps include PET-CT, Panorex and PDL-1 testing.
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  THANK YOU