An institutional analysis of unplanned return to the operating room to identify areas for quality improvement

Lin, Yihan; Meguid, Robert A.; Hosokawa, Patrick; Henderson, William G.; Hammermeister, Karl E.; Schulick, Richard D.; Shelstad, Ryan C.; Wild, Trevor T.; McIntyre, Robert C.

doi:10.1016/j.amjsurg.2016.10.021

Cited by 14 publications

(22 citation statements)

References 14 publications

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“…Over 90% of the patients recovered properly with the median length of stay after UROR being 7 days. UROR has been a critical criteria to measure the quality of surgeries and summary and examinations of features of UROR could provide fundamental insights to improve the level of surgical treatment (5,6). According to our knowledge, this is the first study evaluating the clinical characteristics, causes, and in-operation findings of UROR for lung cancer patients.…”

Section: Discussionmentioning

confidence: 97%

Bleeding is the most common cause of unplanned return to operating room after lung cancer surgeries

Li¹,

Xue²,

Gao³

et al. 2020

J Thorac Dis

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Background: The rate of unplanned return to the operation room (UROR) is an important index for the quality of surgeries. Study of the features and causes of patients who have suffered UROR is key to reduce the risk of it. Methods: A retrospective, observational study was conducted among lung cancer patients who have received lung resections and UROR over a 5-year period. The causes, findings, procedures of UROR and recovery of patients were examined. Results: Among the 23,345 lung cancer surgeries, 64 underwent UROR with the rate being 0.27%.Lobectomy was performed in 78.1% of the patients. The most common indication was post-operative bleeding, responsible for 82.8% (53/64) of the cases. The median length of stay after the second surgery was 7 days and over 90% of the patients were discharged with proper recovery. The death rate within 90 days after return to operation room (OR) was 1.6% (1/64). In the 53 cases caused by bleeding, 27 (50.9%) occurred in surgical sites, with the raw surface of lymph node dissection being most frequently affected.Bleedings on incisions and unknown origin took up 11.3% and 37.7%, respectively. Conclusions: Bleeding is the most common indication which causes over 80% of UROR for lung cancer surgeries. Careful examination and complete hemostasis in surgery is key to reduce the risk of this unwanted complication.

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Section: Discussionmentioning

confidence: 97%

Bleeding is the most common cause of unplanned return to operating room after lung cancer surgeries

Li¹,

Xue²,

Gao³

et al. 2020

J Thorac Dis

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“…Occasionally, the patients experienced more than one uROR during their hospitalization, resulting in the extension of their hospital stays and higher rates of postoperative mortality and morbidity after the second operation. [ 3 ] Herein, the mortality rate in the 24-hour uROR group was higher than that in the control group (crude HR, 2.383; P = .037 and adjusted HR, 2.11; P = .095; Table 3 ). We centered our investigation on the relatively dangerous situation in which patients underwent reoperation within 24 hours.…”

Section: Discussionmentioning

confidence: 88%

“…[ 25 ] Various factors can lead to uROR within 24 hours. Lin et al [ 3 ] reported that surgical site infection and hemorrhage are the most common reasons for 30-day uROR. In our study, the most common reason for 24-hour uROR was bleeding (62.55%).…”

Section: Discussionmentioning

confidence: 99%

Risk factors for unplanned return to the operating room within 24 hours

et al. 2021

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The purpose of the retrospective case–control study was to identify the causes of and risk factors for unplanned return to the operating room (uROR) within 24 hours in surgical patients. We examined 275 cases of 24-hour uROR in our hospital from January 2010 to December 2018. The reasons for 24-hour uROR were classified into several categories. Controls were randomly matched to cases in a 1:1 ratio with the selection criteria set for the same surgeon and operation code in the same corresponding year. The mortality rate was significantly higher in patients with 24-hour uROR (11.63% vs 5.23%). Bleeding was the most common etiology (172/275; 62.55%) and technical error (14.5%) also contributed to 24-hour uROR. The clinical factors that led to bleeding included a history of liver disease ( P = .032), smoking ( P = .002), low platelet count in preoperative screening ( P = .012), and preoperative administration of antiplatelet or anticoagulant agents ( P = .014). Clinicians should recognize the risk factors for bleeding and minimize errors to avoid the increase in patient morbidity and mortality that is associated with 24-hour uROR. Level of Evidence: Level IV.

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“…In an institutional review of surgical outcomes, Lin et al . found that up to 35.3% of reoperation outcomes were recorded incorrectly and that 60% of false unplanned reoperations was due to a lack of adequate documentation . We hope that by focusing only on the initial admission we minimized the potential for including URTTs that were not related to the index operation.…”

Section: Discussionmentioning

confidence: 99%

Monitoring excess unplanned return to theatre following colorectal cancer surgery

Rasmussen

Platell

Jones

2018

ANZ Journal of Surgery

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Background: To develop a risk-adjustment model for unplanned return to theatre (URTT) outcomes following colorectal surgeries in Australia and New Zealand hospitals and apply top-down and bottom-up statistical process control methods for fair comparison of hospitals and surgeons' URTT rates. Methods: We analysed URTT outcomes from hospitals contributing data to the Bi-National Colorectal Cancer Audit clinical registry between 2007 and 2016. Preoperative and intraoperative covariates were considered for risk adjustment. A risk-adjusted rate funnel plot was prepared for between-hospital comparisons and identification of outlying hospitals with unusually high rates of URTT. Cumulative observed-minus-expected charts with cumulative sum signals were then presented for surgeons within an outlying hospital. Results: The study included 15 134 patients and 166 surgeons across 70 hospitals. The weighted average URTT rate was 5.2%. The risk-adjustment model identified 12 preoperative and intraoperative variables that significantly raise the risk of URTT: male sex, American Society of Anesthesiologists score, emergency admissions, conversion entry, left hemicolectomy, total colectomy, proctocolectomy, lower anterior resection, ultra-low anterior resection, abdominoperineal resection, organ resection and excess lymph nodes harvested. Right hemicolectomy significantly reduced risk of URTT. URTT rates were not found to significantly vary across seniority of operator; however, comparisons were limited by lack of data on junior operators. The funnel plot identified five hospitals as 'possible outliers' and hospital T was identified as a 'definite outlier'. The cumulative observed-minus-expected charts with cumulative sum signals showed that within hospital T, one surgeon among three had a particularly bad run of URTTs. Conclusion: Feedback from aggregated URTT outcomes using a risk-adjusted rate funnel plot is enhanced when follow-up examination of outlying hospitals is conducted with concurrent application of cumulative observed-minus-expected charts with cumulative sum signals.

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An institutional analysis of unplanned return to the operating room to identify areas for quality improvement

Cited by 14 publications

References 14 publications

Bleeding is the most common cause of unplanned return to operating room after lung cancer surgeries

Bleeding is the most common cause of unplanned return to operating room after lung cancer surgeries

Risk factors for unplanned return to the operating room within 24 hours

Monitoring excess unplanned return to theatre following colorectal cancer surgery

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