Abstract
BACKGROUND: Return to the operating room (ROR) has been put forth by the National Quality Forum and the American College of Surgeons as a surgical quality indicator. However, current quality metrics fail to consider the nature and etiology of the ROR. OBJECTIVE: To provide a comprehensive description of all reoperations after neurosurgical procedures and assess the validity of ROR as a quality measure in neurosurgery. METHODS: We retrospectively analyzed all neurosurgical procedures performed in a high-volume, tertiary care academic medical center between June 1, 2014 and December 31, 2016. Based on a system constructed and validated at our institution, we classified RORs into (a) unplanned related, (b) planned return due to complications, (c) planned-staged return, or (d) unrelated return. RESULTS: A total of 9200 unique neurosurgical cases were identified, of which 788 had an ROR within 45 d (8.6%). Median time to ROR (interquartile range) was 9 d (4-15). Specifically, 4.2% were planned-staged returns, 3.4% were unplanned related, 0.3% were unrelated, and 0.6% were planned because of previous complications. Cranial procedures had the highest unplanned ROR rate (4.2%), followed by spinal (2.8%) and peripheral nerve (0.4%). The most common reason for an unplanned ROR was wound complication/surgical site infection (34.3%), followed by hematoma evacuation (13.9%) and cerebrospinal fluid (CSF) leak (11.3%). CONCLUSION: Unplanned RORs were relatively rare and most commonly associated with wound complication, postoperative hematoma, and CSF leak. To better reflect surgical quality, ROR metrics should indicate whether the return was planned or unrelated.
| Original language | English (US) |
|---|---|
| Pages (from-to) | E392-E401 |
| Journal | Neurosurgery |
| Volume | 84 |
| Issue number | 6 |
| DOIs | |
| State | Published - Jun 1 2019 |
Fingerprint
Keywords
- Cranial
- Peripheral nerve surgery
- Reoperation
- Return to the operating room
- Spine
ASJC Scopus subject areas
- Surgery
- Clinical Neurology
Cite this
Returns to Operating Room After Neurosurgical Procedures in a Tertiary Care Academic Medical Center : Implications for Health Care Policy and Quality Improvement. / Kerezoudis, Panagiotis; Glasgow, Amy E.; Alvi, Mohammed Ali; Spinner, Robert J.; Meyer, Fredric B.; Bydon, Mohamad; Habermann, Elizabeth B.
In: Neurosurgery, Vol. 84, No. 6, 01.06.2019, p. E392-E401.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Returns to Operating Room After Neurosurgical Procedures in a Tertiary Care Academic Medical Center
T2 - Implications for Health Care Policy and Quality Improvement
AU - Kerezoudis, Panagiotis
AU - Glasgow, Amy E.
AU - Alvi, Mohammed Ali
AU - Spinner, Robert J.
AU - Meyer, Fredric B.
AU - Bydon, Mohamad
AU - Habermann, Elizabeth B
PY - 2019/6/1
Y1 - 2019/6/1
N2 - BACKGROUND: Return to the operating room (ROR) has been put forth by the National Quality Forum and the American College of Surgeons as a surgical quality indicator. However, current quality metrics fail to consider the nature and etiology of the ROR. OBJECTIVE: To provide a comprehensive description of all reoperations after neurosurgical procedures and assess the validity of ROR as a quality measure in neurosurgery. METHODS: We retrospectively analyzed all neurosurgical procedures performed in a high-volume, tertiary care academic medical center between June 1, 2014 and December 31, 2016. Based on a system constructed and validated at our institution, we classified RORs into (a) unplanned related, (b) planned return due to complications, (c) planned-staged return, or (d) unrelated return. RESULTS: A total of 9200 unique neurosurgical cases were identified, of which 788 had an ROR within 45 d (8.6%). Median time to ROR (interquartile range) was 9 d (4-15). Specifically, 4.2% were planned-staged returns, 3.4% were unplanned related, 0.3% were unrelated, and 0.6% were planned because of previous complications. Cranial procedures had the highest unplanned ROR rate (4.2%), followed by spinal (2.8%) and peripheral nerve (0.4%). The most common reason for an unplanned ROR was wound complication/surgical site infection (34.3%), followed by hematoma evacuation (13.9%) and cerebrospinal fluid (CSF) leak (11.3%). CONCLUSION: Unplanned RORs were relatively rare and most commonly associated with wound complication, postoperative hematoma, and CSF leak. To better reflect surgical quality, ROR metrics should indicate whether the return was planned or unrelated.
AB - BACKGROUND: Return to the operating room (ROR) has been put forth by the National Quality Forum and the American College of Surgeons as a surgical quality indicator. However, current quality metrics fail to consider the nature and etiology of the ROR. OBJECTIVE: To provide a comprehensive description of all reoperations after neurosurgical procedures and assess the validity of ROR as a quality measure in neurosurgery. METHODS: We retrospectively analyzed all neurosurgical procedures performed in a high-volume, tertiary care academic medical center between June 1, 2014 and December 31, 2016. Based on a system constructed and validated at our institution, we classified RORs into (a) unplanned related, (b) planned return due to complications, (c) planned-staged return, or (d) unrelated return. RESULTS: A total of 9200 unique neurosurgical cases were identified, of which 788 had an ROR within 45 d (8.6%). Median time to ROR (interquartile range) was 9 d (4-15). Specifically, 4.2% were planned-staged returns, 3.4% were unplanned related, 0.3% were unrelated, and 0.6% were planned because of previous complications. Cranial procedures had the highest unplanned ROR rate (4.2%), followed by spinal (2.8%) and peripheral nerve (0.4%). The most common reason for an unplanned ROR was wound complication/surgical site infection (34.3%), followed by hematoma evacuation (13.9%) and cerebrospinal fluid (CSF) leak (11.3%). CONCLUSION: Unplanned RORs were relatively rare and most commonly associated with wound complication, postoperative hematoma, and CSF leak. To better reflect surgical quality, ROR metrics should indicate whether the return was planned or unrelated.
KW - Cranial
KW - Peripheral nerve surgery
KW - Reoperation
KW - Return to the operating room
KW - Spine
UR - http://www.scopus.com/inward/record.url?scp=85066503201&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85066503201&partnerID=8YFLogxK
U2 - 10.1093/neuros/nyy429
DO - 10.1093/neuros/nyy429
M3 - Article
C2 - 30299515
AN - SCOPUS:85066503201
VL - 84
SP - E392-E401
JO - Neurosurgery
JF - Neurosurgery
SN - 0148-396X
IS - 6
ER -