Unplanned Return to the Operating Room

BACKGROUND: Unplanned return to the operating room (OR) has been suggested as one of the indicators that could be used to assess the quality of surgery in a hospital setting. The present study was undertaken in order to try to identify those factors that were important in determining the need for the return to the OR in patients undergoing a series of colorectal surgical procedures. METHODS: All patients who returned to the OR following an index colorectal procedure during a 15-year period on a colorectal service, were identified from the unit's database. The site of original disease, presentation, type of surgery performed, reason for re-operation and post-surgical morbidity and mortality were examined. RESULTS: Overall there were 2011 colorectal surgical admissions, and of these 19 males (61.2 years) and 18 females (67.4 years) underwent an unplanned return to the OR. In 34 patients the index operation was performed by a consultant surgeon. A total of 46% of index operations were performed in an emergency setting. The majority of patients had colorectal cancer. Most lesions were situated in the sigmoid colon or rectum. Postoperative adhesive obstruction was the commonest reason for return to the OR. No patient re-obstructed following re-operation. Overall eight wounds dehisced and five patients suffered anastomotic leakage. Intra-abdominal sepsis was found in 12 patients. Twenty-one patients developed urinary tract infections. Twenty-eight patients were discharged well, two patients were discharged dying with advanced malignancy and there were seven postoperative deaths (18.9%). CONCLUSIONS: Unplanned return to the OR is a function of both the patient's presenting problem and the surgical skill and judgement of the surgeon. It is thus in part determined by the patient casemix in a unit, service or institution.