Content analysis of unstructured operative records can evaluate nuanced techniques in complex operations

Abstract Purpose Recently, poor function and incontinence after Hirschsprung Disease Surgery has been reported more frequently. Reports listing the causes and recommending how to manage incontinence are published, but no review identifies operative steps which avoid this problem initially. We hypothesized that specific techniques in the operation, which would ensure preservation of the anal sphincter with improved function, can be identified with content analysis. Methods This is a review of patients that underwent “proctectomy and pull-through surgery” for Hirschsprung disease. Text phrases considered significant components of the operation were abstracted from the original published description and identified in unstructured operative reports using content analysis. The outcome of bowel function was documented as a function of the inclusion of each text phrase. Results Eighty four charts were chosen for analysis. The average age at the procedure was 7 months (1–36). 47 of 84 (55%) of patients had a functionally successful pull through recorded as “normal bowel function” (NBF), 12 (14%) were classified as “constipated” and 25(29%) were classified as “incontinent”. Each of five text phrases, when documented in the record, was associated with outcome improvement where NBF was reported in 80–90%. Conclusion It is important to assess procedures and understand what methods lead to a desired result. Complex operations can have many variations not identified by CPT code or templated reports. Using content analysis, specific nuances can be identified which lead to improvement of outcome. It is felt that creating unstructured reports is also a valuable educational exercise.