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

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

doi:10.1016/j.amjsurg.2016.10.021

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

Am J Surg. 2017 Jul;214(1):1-6. doi: 10.1016/j.amjsurg.2016.10.021. Epub 2016 Dec 13.

Authors

Yihan Lin¹, Robert A Meguid², Patrick W Hosokawa³, William G Henderson⁴, Karl E Hammermeister⁵, Richard D Schulick², Ryan C Shelstad⁶, Trevor T Wild⁶, Robert C McIntyre Jr⁶

Affiliations

¹ Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA; Surgical Outcomes and Applied Research Program, University of Colorado School of Medicine, Aurora, CO, USA. Electronic address: yihan.lin@ucdenver.edu.
² Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA; Surgical Outcomes and Applied Research Program, University of Colorado School of Medicine, Aurora, CO, USA.
³ Surgical Outcomes and Applied Research Program, University of Colorado School of Medicine, Aurora, CO, USA.
⁴ Surgical Outcomes and Applied Research Program, University of Colorado School of Medicine, Aurora, CO, USA; Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, CO, USA; Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO, USA.
⁵ Surgical Outcomes and Applied Research Program, University of Colorado School of Medicine, Aurora, CO, USA; Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, CO, USA; Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA.
⁶ Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA.

PMID: 28057294
DOI: 10.1016/j.amjsurg.2016.10.021

Abstract

Background: Unplanned return to the operating room (uROR) has been suggested as a hospital quality indicator. The purpose of this study was to determine reasons for uROR to identify opportunities for patient care improvement.

Methods: uROR reported by our institution's American College of Surgeons National Surgical Quality Improvement Program underwent secondary review.

Results: The uROR rate reported by clinical reviewers was 4.3%. Secondary review re-categorized 64.7% as "true uROR" with the most common reasons for uROR being infection (30.9%) and bleeding (23.6%). Remaining cases were categorized as "false uROR" with the most common reasons being inadequate documentation (60.0%) and not directly related to index procedure (16.7%).

Conclusions: Strict adherence to NSQIP definitions results in misidentification of true uROR. This raises concerns for using NSQIP-identified uROR as a hospital quality metric. Improved processes of care to prevent infection and hemorrhage at our institution could reduce the rate of true uROR.

Keywords: ACS; NSQIP; Quality improvement; Reoperation; Unplanned return to the operating room.

MeSH terms

Clinical Audit
Colorado / epidemiology
Databases, Factual
Female
Hospital Mortality
Hospitalization
Humans
Infection Control / methods
Infection Control / statistics & numerical data
Length of Stay / statistics & numerical data
Male
Middle Aged
Operative Time
Patient Transfer / statistics & numerical data
Postoperative Complications / surgery*
Quality Improvement*
Reoperation / statistics & numerical data*
Retrospective Studies