Danique Heuvelings

82 Chapter 3 c. continued After discharge – 30 days AND 90 days  Not applicable POD of AL diagnosis: …… days Mortality:  Y es: POD ……  No Readmission Diagnostic modality Re-interventions after initial discharge Stoma Anastomotic complication  Yes LOS: …… days ICU LOS: …… days  No  N/A  C T scan - POD: …… Contrast: PO / IV / rectal / NA  E ndoscopy - POD: ……  C ontrast enema - POD: ……  S urgical - POD: ……  EUA ͳ Transabdominal: minimal invasive / open  None  Antibiotics  R adiological drainage - POD: …… ͳ Trans-abdominal ͳ Trans-gluteal  T ransanal/endoscopic repair - POD: …… ͳ Endosponge ͳ Repair ͳ Clipping ͳ Drainage ͳ Dilatation  A bdominal: minimal invasive / open - POD: …… ͳ Takedown ͳ Repair ͳ Redo ͳ Drainage ͳ Tissue flap ͳ Stoma creation  Other: …… Creation  NA  Yes ͳ Ileostomy • Loop • End ͳ Colostomy • Loop • End Stoma closure  N/A  Y es: POD ……  Reversal planned  No: ͳ Ongoing leak ͳ Medically ineligible ͳ Ongoing cancer tx ͳ Patient declined ͳ Other: ……  Resolved/None  Leak ͳ Defect, dehiscence or sinus ͳ Stricture or stenosis ͳ Fistula ͳ Osteomyelitis

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