Review of morbidities and mortality has been the primary method used to assess surgical quality by physicians, hospitals, and oversight agencies. The incidence of reoperation has been proposed as a candidate quality indicator for surgical care. The authors report a comprehensive assessment of reoperations within a neurosurgical department and discuss how such data can be integrated into quality improvement initiatives to optimize value of care delivery.
All neurosurgical procedures performed in the main operating room or the outpatient surgery center at the Ronald Reagan UCLA Medical Center and UCLA Santa Monica Medical Center from July 2008 to December 2012 were considered for this study. Interventional radiology and stereotactic radiosurgery procedures were excluded. Early reoperations within 7 days of the index surgery were reviewed and their preventability status was evaluated.
The incidence of early unplanned reoperation was 2.6% (occurring after 183 of 6912 procedures). More than half of the patients who underwent early unplanned reoperation initially had surgery for shunt-related conditions (34.4%) or intracranial tumor (23.5%). Shunt failure was the most common indication for early unplanned reoperation (34.4%), followed by postoperative bleeding (20.8%) and postoperative elevated intracranial pressure (9.8%). The average time interval (± SD) between the index surgery and reoperation was 3.0 ± 1.9 days. The average length of stay following reoperation was 12.1 ± 14.4 days.
This study enabled an in-depth assessment of reoperations within an academic neurosurgical practice and identification of strategic opportunities for department-wide quality improvement initiatives. The authors provide a nuanced discussion regarding the use of absolute reoperations as a quality indicator for neurosurgical patient populations.
Drs. McLaughlin and Jin contributed equally to this work.
INCLUDE WHEN CITING Published online March 27, 2015; DOI: 10.3171/2014.9.JNS14666.
DISCLOSURE The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.
Almoudaris AM, , Burns EM, , Mamidanna R, , Bottle A, , Aylin P, & Vincent C, et al.: Value of failure to rescue as a marker of the standard of care following reoperation for complications after colorectal resection. Br J Surg 98:1775–1783, 2011
Ansari MZ, & Collopy BT: The risk of an unplanned return to the operating room in Australian hospitals. Aust N Z J Surg 66:10–13, 1996
Baker GR, , Norton PG, , Flintoft V, , Blais R, , Brown A, & Cox J, et al.: The Canadian Adverse Events Study: the incidence of adverse events among hospital patients in Canada. CMAJ 170:1678–1686, 2004
Birkmeyer JD, , Hamby LS, , Birkmeyer CM, , Decker MV, , Karon NM, & Dow RW: Is unplanned return to the operating room a useful quality indicator in general surgery?. Arch Surg 136:405–411, 2001
Brennan TA, , Leape LL, , Laird NM, , Hebert L, , Localio AR, & Lawthers AG, et al.: Incidence of adverse events and negligence in hospitalized patients. Results of the Harvard Medical Practice Study I. N Engl J Med 324:370–376, 1991
Clavien PA, , Sanabria JR, & Strasberg SM: Proposed classification of complications of surgery with examples of utility in cholecystectomy. Surgery 111:518–526, 1992
Daley J, , Khuri SF, , Henderson W, , Hur K, , Gibbs JO, & Barbour G, et al.: Risk adjustment of the postoperative morbidity rate for the comparative assessment of the quality of surgical care: results of the National Veterans Affairs Surgical Risk Study. J Am Coll Surg 185:328–340, 1997
de Vries EN, , Ramrattan MA, , Smorenburg SM, , Gouma DJ, & Boermeester MA: The incidence and nature of in-hospital adverse events: a systematic review. Qual Saf Health Care 17:216–223, 2008
Dierks MM, , Huang ZS, , Siracuse JJ, , Tolchin S, & Moorman DW: Diagnostic, surgical judgment, and systems issues leading to reoperation: mining administrative databases. Am J Surg 199:324–330, 2010
Dimick JB, , Welch HG, & Birkmeyer JD: Surgical mortality as an indicator of hospital quality: the problem with small sample size. JAMA 292:847–851, 2004
Drake JM, , Riva-Cambrin J, , Jea A, , Auguste K, , Tamber M, & Lamberti-Pasculli M: Prospective surveillance of complications in a pediatric neurosurgery unit. J Neurosurg Pediatr 5:544–548, 2010
Griffin FA, & Classen DC: Detection of adverse events in surgical patients using the Trigger Tool approach. Qual Saf Health Care 17:253–258, 2008
Guevara OA, , Rubio-Romero JA, & Ruiz-Parra AI: Unplanned reoperations: is emergency surgery a risk factor? A cohort study. J Surg Res 182:11–16, 2013
Halfon P, , Eggli Y, , Matter M, , Kallay C, , van Melle G, & Burnand B: Risk-adjusted rates for potentially avoidable reoperations were computed from routine hospital data. J Clin Epidemiol 60:56–67, 2007
Houkin K, , Baba T, , Minamida Y, , Nonaka T, , Koyanagi I, & Iiboshi S: Quantitative analysis of adverse events in neurosurgery. Neurosurgery 65:587–594, 2009
Isbister WH: Unplanned return to the operating room. Aust N Z J Surg 68:143–146, 1998
Krell RW, , Hozain A, , Kao LS, & Dimick JB: Reliability of risk-adjusted outcomes for profiling hospital surgical quality. JAMA Surg 149:467–474, 2014
Marini H, , Merle V, , Derrey S, , Lebaron C, , Josset V, & Langlois O, et al.: Surveillance of unplanned return to the operating theatre in neurosurgery combined with a mortality—morbidity conference: results of a pilot survey. BMJ Qual Saf 21:432–438, 2012
McSorley S, , Lowndes C, , Sharma P, & Macdonald A: Unplanned reoperation within 30 days of surgery for colorectal cancer in NHS Lanarkshire. Colorectal Dis 15:689–694, 2013
Merkow RP, , Bilimoria KY, , Cohen ME, , Richards K, , Ko CY, & Hall BL: Variability in reoperation rates at 182 hospitals: a potential target for quality improvement. J Am Coll Surg 209:557–564, 2009
Mukerji N, , Jenkins A, , Nicholson C, & Mitchell P: Unplanned reoperation rates in pediatric neurosurgery: a single center experience and proposed use as a quality indicator. J Neurosurg Pediatr 9:665–669, 2012
Ng RL, , Davies AH, , Magee TR, , Tennant S, , Horrocks M, & Baird RN: Early reoperation rates after arterial surgery. Eur J Vasc Surg 8:78–82, 1994
Ploeg AJ, , Lange CP, , Lardenoye JW, & Breslau PJ: The incidence of unplanned returns to the operating room after peripheral arterial bypass surgery and its value as indicator of quality of care. Vasc Endovascular Surg 42:19–24, 2008
Potluri V, & Lavu H: Unplanned reoperation rate as a measure for hospital quality. J Surg Res 185:520–521, 2013
Theodosopoulos PV, , Ringer AJ, , McPherson CM, , Warnick RE, , Kuntz C IV, & Zuccarello M, et al.: Measuring surgical outcomes in neurosurgery: implementation, analysis, and auditing a prospective series of more than 5000 procedures. J Neurosurg 117:947–954, 2012
Vincent C, , Neale G, & Woloshynowych M: Adverse events in British hospitals: preliminary retrospective record review. BMJ 322:517–519, 2001. (Erratum in BMJ 322: 1395, 2001)
All Time | Past Year | Past 30 Days | |
---|---|---|---|
Abstract Views | 670 | 403 | 43 |
Full Text Views | 1088 | 6 | 0 |
PDF Downloads | 692 | 11 | 0 |
EPUB Downloads | 0 | 0 | 0 |