Reoperations within 48 hours following 7942 pediatric neurosurgery procedures

Abstract

<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>Various indicators are used to evaluate the quality of care delivered by surgical services, one of which is early reoperation rate. The indications and rate of reoperations within a 48-hour time period have not been previously reported for pediatric neurosurgery.</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>Between May 1, 2009, and December 30, 2014, 7942 surgeries were performed by the pediatric neurosurgery service in the operating rooms at a single institution. Demographic, socioeconomic, and clinical characteristics associated with each of the operations were prospectively collected. The procedures were grouped into 31 categories based on the nature of the procedure and underlying diseases. Reoperations within 48 hours at the conclusion of the index surgery were reviewed to determine whether the reoperation was planned or unplanned. Multivariate logistic regression was employed to analyze risk factors associated with unplanned reoperations.</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>Cerebrospinal fluid shunt–and hydrocephalus-related surgeries accounted for 3245 (40.8%) of the 7942 procedures. Spinal procedures, craniotomy for tumor resections, craniotomy for traumatic injury, and craniofacial reconstructions accounted for an additional 8.7%, 6.8%, 4.5%, and 4.5% of surgical volume. There were 221 reoperations within 48 hours of the index surgery, yielding an overall incidence of 2.78%; 159 of the reoperation were unplanned. Of these 159 unplanned reoperations, 121 followed index operations involving shunt manipulations. Using unplanned reoperations as the dependent variable (n = 159), index operations with a starting time after 3 <jats:sc>pm</jats:sc> and admission through the emergency department (ED) were associated with a two- to threefold increase in the likelihood of reoperations (after-hour surgery, odds ratio [OR] 2.01 [95% CI 1.43–2.83, p &lt; 0.001]; ED admission, OR 1.97 (95% CI 1.32–2.96, p &lt; 0.05]).</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>Approximately 25% of the reoperations within 48 hours of a pediatric neurosurgical procedure were planned. When reoperations were unplanned, contributing factors could be both surgeon related and system related. Further study is required to determine the extent to which these reoperations are preventable. The utility of unplanned reoperation as a quality indicator is dependent on proper definition, analysis, and calculation.</jats:p></jats:sec>

Risk Factors and Outcomes of Redo Craniotomy: A Tertiary Care Center Analysis

“…In the pediatric population, Mukerji et al report a 17% 30-day reoperation rate at their center in the United Kingdom with 44% of all operations were related to CSF diversion [19]. Similarly, when looking at a 48-hour reoperation rate, CSF shunt placement and hydrocephalus were the major indications (40.8%) reported by Roy et al, which is reflected in our patients as well [20].…”

The Incidence and Causes of Unplanned Reoperations as a Quality Indicator in Pediatric Surgery

“…Despite the statistical significance, we could not declare later starting time as a risk factor because we lacked information for all the reoperated patients. Roy et al showed that performing surgeries after 5 p.m. is a risk factor for unplanned reoperations [ 20 ]. Similarly, Li et al stated that unplanned reoperations occur more often if the surgeries are finished after hours [ 13 ].…”

Analysis of neurosurgical procedures with unplanned reoperation for quality improvement

“…The rates of shunt-related unplanned reoperations among all unplanned reoperation patients were 78% and 73.5%, respectively. The overall rate of unplanned shunt-related reoperation among surgeries was 22% (91/410) in the 2-year follow-up in Mukerji et al's study, [13] and 1.47% (117/7942) within 48 hours postoperatively in Roy et al's study [12] . McLaughlin et al reviewed their shunt failure cases, which accounted for 34.4% (63 [pedi/adult: 36/27]/183) of all early unplanned returns and 0.39% (27/6912) among all surgeries within 7 days post-operation [14] .…”

“…[ 23 24 25 ] In the adult population, the preventable unplanned shunt implantation return rate has also been proposed as a possible external comparison quality metric. [26] Reviewing the literature on UROR related to CSF diversion, Mukerji et al [13] and Roy et al [12] previously reported that shunt-related procedures accounted for 44% and 40.8% of all pediatric procedures at their study institutions, respectively. The rates of shunt-related unplanned reoperations among all unplanned reoperation patients were 78% and 73.5%, respectively.…”

“…The overall rate of unplanned shunt-related reoperation among surgeries was 22% (91/410) in the 2-year follow-up in Mukerji et al's study, [13] and 1.47% (117/7942) within 48 hours postoperatively in Roy et al's study. [12] McLaughlin et al reviewed their shunt failure cases, which accounted for 34.4% (63 [pedi/adult: 36/27]/183) of all early unplanned returns and 0.39% (27/6912) among all surgeries within 7 days post-operation. [14] Panagiotis et al reported that the rate of shunt-related unplanned reoperation among all unplanned reoperation patients was 13.5% (42/311) and 0.46% (42/9200) among all surgeries within 45 days.…”