Unplanned reoperation rates in pediatric neurosurgery: a single center experience and proposed use as a quality indicator

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>The pediatric neurosurgery practice over 2 years was reviewed at a tertiary neurosciences center. The intention was to establish the frequency of unplanned reoperations at the center, investigate the factors responsible, and consider using unplanned reoperations as a quality indicator.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>All pediatric neurosurgical operations done between January 2008 and January 2010 were reviewed using data from operation theater logs and hospital records. Data were recorded as per the standard requirements of the Society of British Neurological Surgeons for incorporation into the national database. “Unplanned reoperation” was defined as any unscheduled secondary procedure required for a complication resulting directly or indirectly from the index operation or as an unscheduled return to the operating theater for the same condition. Operations were defined as “urgent” if they had to be performed out of hours (that is, outside the hours of 8:00 a.m. to 5:00 p.m.), “emergency elective” if they were included on the emergency list but within working hours, and “routine elective” if they were on the scheduled operations list. Both overall and 30-day unplanned reoperation rates were considered. Factors influencing unplanned reoperations were explored using a logistic regression model.</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>Four hundred ten operations were analyzed. The overall unplanned reoperation rate was 28%. The median time to an unplanned reoperation was 9 days. Risk factors for unplanned reoperations included a CSF diversion procedure (OR 7, p &lt; 0.0001) and an urgent procedure (OR 2.5, p = 0.02, higher unplanned reoperations for urgent procedures relative to routine electives). The 30-day unplanned reoperation rate was 17%. Urgent cases composed 32% of all operations. Trainees performed 52% of the urgent operations. Forty-four percent of all operations were related to CSF diversion. Sixty-four percent of patients had reoperations during the course of the study period, and 44% of these reoperations were unplanned.</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>An unplanned return to the operation theater is common in the authors' pediatric neurosurgical practice and is procedure specific. Unplanned reoperation rates may be useful for monitoring quality across hospitals and identifying opportunities for quality improvement. The authors propose the use of this index as a quality indicator and advocate its validation in a prospective multicenter study.</jats:p></jats:sec>

Prospective review of a single center's general pediatric neurosurgical intraoperative and postoperative complication rates

“…The overall unplanned 30-day RTOR in our series was 10.5% and that in the Toronto series was 10.4%, 5 whereas this rate was 17% in a British single pediatric neurosurgery institution series. 15 In the latter series, the unplanned reoperation rate increased to 28% during the 2-year follow-up study period. 15 In Toronto, all patients were treated by pediatric neurosurgeons with a much higher caseload than in our institution.…”

“…15 In the latter series, the unplanned reoperation rate increased to 28% during the 2-year follow-up study period. 15 In Toronto, all patients were treated by pediatric neurosurgeons with a much higher caseload than in our institution. Toronto is therefore a good reference for comparison with our study.…”

“…12,15 However, if used for comparison between institutions, case mix correction has to be performed because different procedures have different rates of RTOR (CSF procedures had a 7-fold increased risk of RTOR and surgery out-of-hours had a 2.5-fold increase as compared with elective surgery in the series of Mukerji et al 15 ).…”

Assessing early unplanned reoperations in neurosurgery: opportunities for quality improvement

“…18,21 Mukerji and colleagues noted that the 30-day unplanned reoperation rate was 17% in a pediatric neurosurgical service. 21 They defined an unplanned reoperation as "any unscheduled secondary procedure required for a complication resulting directly or indirectly from the index operation or as an unscheduled return to the OR for the same condition." In their study, CSF diversion procedures represented the highest risk factor for reoperations.…”

“…18,21 As departments aim to deliver optimal value of care, understanding the incidence and causes of reoperations, specifically unplanned reoperations, is critical, given their medical impact on the patient and financial impact on health care.…”