Is Unplanned Return to the Operating Room a Useful Quality Indicator in General Surgery?

Abstract

Hypothesis: To test our hypothesis that unplanned return to the operating room (OR) is a useful quality indicator, we examined how often and for what reasons patients go back to the OR in a broad-based general surgery practice. Design and Setting: Prospective cohort study at a rural tertiary care center. Patients: Consecutive series of 3044 patients undergoing general surgery procedures in the OR between September 1, 1998, and March 31, 2000. Information about all postoperativeadverseeventsoccurringbeforedischargeorwithin 30 days (whichever was longer) was collected prospectively. Unplanned return to the OR was defined as any secondary procedure required for a complication resulting directly or indirectly from the index operation. Main Outcome Measures: Unplanned return to the OR, mortality, and hospital charges. Results: Overall, 107 (3.5%) had an unplanned return to the OR. A relatively small number of inpatient procedures accounted for a disproportionate share of unplanned re

Editorial: Does it pass the sniff test? Mining the NSQIP-P database for neurosurgical diseases

“…Indeed, 30-day outcomes have been proposed by general surgeons as quality indicators. 2 However, we point out in our study that this time frame and these definitions are not particularly applicable to pediatric neurosurgery.…”

“…2 They present a detailed analysis of postoperative complications, return to the operating room, or unplanned readmissions within 30 days of postnatal myelomeningocele closure in 114 patients. Three general types of information were examined: epidemiological (patient age, gestational age, sex, race and ethnicity, weight, American Society of Anesthesiologists physical status); intraoperative (operative time in minutes, use of a subspecialty team for wound closure, simultaneous shunt placement); and 30-day outcomes (various NSQIP-P-defined complications, return to the operating room, unplanned admissions).…”

Assessing early unplanned reoperations in neurosurgery: opportunities for quality improvement

“…Information extracted from the databases and verified and completed by chart review included but was not limited to preoperative diagnoses for the index surgery, title of index surgery and date, indication of reoperations, title of reoperation surgery and date, length of admissions (index hospitalization and readmission if existing), case status (elective vs emergent/urgent), 4 and reoperation status (planned vs unplanned). Two independent reviewers (N.M. and P.J.)…”

“…10,17,20 In recent years, the reoperation rate, defined as the percentage of patients undergoing a new operation, has been proposed as a quality indicator, a surrogate for surgical adverse events. 4,13,19,24 General surgery has been at the forefront of assessing reoperations. Reported rates have varied widely (0.6% to 9.4%) depending on the definition, method of detection, case selection criteria, heterogeneity of practices, and difference in department and hospital practic- OBJect Review of morbidities and mortality has been the primary method used to assess surgical quality by physicians, hospitals, and oversight agencies.…”

“…Reported rates have varied widely (0.6% to 9.4%) depending on the definition, method of detection, case selection criteria, heterogeneity of practices, and difference in department and hospital practic-es. 4,9,20 Therefore, the appropriateness of the "absolute" rate of reoperations as a quality indicator enabling quality improvement and comparison between departments and organizations has been questioned.…”