December 10, 2021Open Access

Risk factors for unplanned return to the operating room within 24 hours

Q: What is the clinical evidence from this study?

Study design: Case-Control. Population: Surgical patients (n=550). Intervention: Unplanned return to the operating room (uROR) within 24 hours vs. Matched controls without uROR. Primary outcome: Mortality rate.

Key Result

Unplanned return to the operating room within 24 hours was associated with a significantly higher mortality rate compared to matched controls (11.63% vs 5.23%).

Study Design

Type

Case-Control (n=550)

Multicenter

Structured PICO

What are the risk factors for unplanned return to the operating room within 24 hours in surgical patients?

Population

550 surgical patients, comprising 275 cases of 24-hour unplanned return to the operating room and 275 matched controls, treated between 2010 and 2018.

Exposure

Unplanned return to the operating room (uROR) within 24 hours

Comparator

Matched controls without uROR (matched 1:1 for same surgeon, operation code, and year)

Outcome

Causes of and risk factors for unplanned return to the operating room within 24 hourssafety

Preoperative identification of bleeding risk factors, including antiplatelet or anticoagulant use, is crucial to minimize unplanned returns to the operating room and associated mortality.

Main Result

Absolute Event Rate: 11.63% vs 5.23%

Abstract

ABSTRACT: The purpose of the retrospective case-control study was to identify the causes of and risk factors for unplanned return to the operating room (uROR) within 24 hours in surgical patients.We examined 275 cases of 24-hour uROR in our hospital from January 2010 to December 2018. The reasons for 24-hour uROR were classified into several categories. Controls were randomly matched to cases in a 1:1 ratio with the selection criteria set for the same surgeon and operation code in the same corresponding year.The mortality rate was significantly higher in patients with 24-hour uROR (11.63% vs 5.23%). Bleeding was the most common etiology (172/275; 62.55%) and technical error (14.5%) also contributed to 24-hour uROR. The clinical factors that led to bleeding included a history of liver disease (P = .032), smoking (P = .002), low platelet count in preoperative screening (P = .012), and preoperative administration of antiplatelet or anticoagulant agents (P = .014).Clinicians should recognize the risk factors for bleeding and minimize errors to avoid the increase in patient morbidity and mortality that is associated with 24-hour uROR.Level of Evidence: Level IV.

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