Predictors of Unplanned Returns to the Operating Room within 30 Days in Neurosurgery: Insights from a National Surgical Registry

Background: In the modern, increasingly pay-for-performance era, unplanned return to the operating room (ROR) is gaining attention as a surgical quality metric. However, large-scale data on the appropriateness and usefulness of this measure in neurosurgery are scarce. Objective: To provide a comprehensive description of all RORs after neurosurgical procedures in a national surgical registry and identify factors associated with ROR. Methods: We queried the American College of Surgeons National Surgical Quality Improvement Program multicenter database for patients undergoing neurosurgical procedures during 2012–2016. Multivariable logistic regression was conducted to identify factors associated with 30-day unplanned ROR after the 3 most common inpatient cranial and spinal operations: craniotomy for intra-axial neoplasm, convexity/falx meningioma, or skull base tumors; anterior cervical discectomy and fusion; and posterior lumbar decompression and posterior lumbar fusion. Results: A total of 193,459 cases were identified, of which 7067 (3.7%) had at least 1 unplanned ROR within 30 days after the index procedure (inpatient, 4.3%; outpatient, 1.5%). Overall, the most common reasons were wound complication/surgical site infection (0.7%), hematoma evacuation (0.6%), and repeat surgery (0.5%). On multivariable analysis, the relative amount of variation in reoperation risk was found to be 1%–24% for demographics, 1%–19% for comorbidities, 1%–6% for preoperative laboratory values, and 4%–58% for operative characteristics. Conclusions: These findings may inform stakeholders on the optimal parameters that need to be taken into account when crafting, endorsing, and implementing quality metrics for neurosurgery that aim to assess surgical performance and reward or penalize hospitals and providers.