Unplanned surgical reoperations as a quality indicator in pediatric tertiary general surgical specialties

Abstract

Unplanned reoperations have not been studied extensively in pediatric patients, especially concerning risk factors. We aim to estimate the rate of unplanned reoperations and to determine the associated factors in pediatric general surgical specialties. This analysis included a retrospective case–control study of unplanned reoperations from July 1, 2010 to June 30, 2017 in the general surgical specialties. For each case, we identified approximately 2 randomly selected controls who underwent the same type of operation. The factors involved in the unplanned reoperations were investigated using univariate and multivariate analysis. Of the 3263 patients who underwent surgery, unplanned reoperations were performed in 139 patients (4.3%). The main indications for unplanned reoperations were wound complications (n = 52, 42.6%), followed by postoperative ileus (n = 12, 9.8%), postoperative bleeding (n = 8, 6.6%), and intraabdominal infection (n = 13, 10.7%). Following multivariate analysis, 2 factors remained significantly associated with unplanned reoperation: higher initial surgery-related risk level (P = .007, risk ratio (RR) = 0.48; 95% confidence interval (CI) = 0.27–0.82) and operation performed outside working hours (P = .031, RR = 0.52; 95% CI = 0.30–0.89). Various patient- and procedure-related factors were associated with unplanned reoperations. This information might be helpful for the optimization of treatment planning and resource allocation.

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

“…In this study, the number of male patients (73.7%) was statistically significantly higher than the number of female patients (26.3%). Those results are compatible with results in other similar studies [ 13 , 17 , 18 , 19 ]. It is important, though, to compare the study subjects to the overall population of pediatric patients operated on during the study period.…”

“…The unplanned return to the operating room occurred in 0.5% of all patients. Incidence of reoperations in literature ranges from 0.8% to 17%, depending on the surgery field [ 9 , 13 , 16 , 17 , 18 , 19 ]. By comparing the data, we can observe that incidence of unplanned reoperations in present study is very low, which would attribute to the great surgery quality in our department.…”

“…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 ].…”

“…Unplanned reoperations are also reliable because they are only performed when necessary and their incidence is easily tracked using administrative registries [ 11 , 12 ]. The incidence of unplanned reoperations in pediatric surgery varies from 0.8 to 7% in general pediatric surgery and up to 17% in pediatric neurosurgery [ 13 , 14 ]. Information about unplanned reoperations can be used to compare different hospitals, different wards, and even to make inside evaluation of surgical teams and surgeons.…”

“…That way, one can find an adequate health care facility for the required procedure. Furthermore, evaluating and tracking postoperative complications such as unplanned reoperations can raise awareness of complications and surgical errors [ 13 ]. Identifying risk factors for unplanned reoperations could help to improve quality of surgery, minimize duration of hospital stay and the increased cost of treatment when unplanned reoperation occurs.…”