Birkmeyer J D, Hamby L S, Birkmeyer C M, Decker M V, Karon N M, Dow R W
VA Outcomes Group (111B), Department of Veterans Affairs Medical Center, White River Junction, VT 05009, USA.
Arch Surg. 2001 Apr;136(4):405-11. doi: 10.1001/archsurg.136.4.405.
To test our hypothesis that unplanned return to the operating room (OR) is a useful quality indicator, we examined how often and for what reasons patients go back to the OR in a broad-based general surgery practice.
Prospective cohort study at a rural tertiary care center.
Consecutive series of 3044 patients undergoing general surgery procedures in the OR between September 1, 1998, and March 31, 2000. Information about all postoperative adverse events occurring before discharge or within 30 days (whichever was longer) was collected prospectively. Unplanned return to the OR was defined as any secondary procedure required for a complication resulting directly or indirectly from the index operation.
Unplanned return to the OR, mortality, and hospital charges.
Overall, 107 (3.5%) had an unplanned return to the OR. A relatively small number of inpatient procedures accounted for a disproportionate share of unplanned reoperations, including colon resection (18% of total reoperations), renal transplant (9%), gastric bypass (6%), and pancreatic resection (6%). As expected, hospital charges were markedly higher for patients with unplanned returns to the OR. Reoperation was also associated with higher mortality rates; statistically significant increases were noted for pancreatic resection (33% vs 3.7%; P =.04), esophagogastrectomy (100% vs 4.2%; P =.002), and laparoscopic Nissen fundoplication (50% vs 0%; P =.01). Overall, 91 reoperations (85%) were for complications occurring at the original surgical site, including those related to an anastomosis (n = 16), surgical wound (n = 21), infection (n = 16), bleeding (n = 12), and other (n = 26).
Unplanned returns to the OR occur across a broad spectrum of general surgical procedures and carry significant implications. Because they most often reflect problems related to the procedure itself, reoperation rates may be useful for monitoring quality across hospitals and for identifying opportunities for quality improvement locally.
为验证我们的假设，即非计划重返手术室（OR）是一项有用的质量指标，我们在广泛的普通外科手术实践中研究了患者重返手术室的频率及原因。
在一家农村三级医疗中心进行的前瞻性队列研究。
1998年9月1日至2000年3月31日期间在手术室接受普通外科手术的3044例连续患者。前瞻性收集所有出院前或30天内（以较长者为准）发生的术后不良事件信息。非计划重返手术室定义为因初次手术直接或间接导致的并发症而需要进行的任何二次手术。
非计划重返手术室、死亡率和住院费用。
总体而言，107例（3.5%）患者非计划重返手术室。相对较少的住院手术占非计划再次手术的比例过高，包括结肠切除术（占总再次手术的18%）、肾移植（9%）、胃旁路手术（6%）和胰腺切除术（6%）。正如预期的那样，非计划重返手术室的患者住院费用明显更高。再次手术也与更高的死亡率相关；胰腺切除术（33%对3.7%；P = 0.04）、食管胃切除术（100%对4.2%；P = 0.002）和腹腔镜尼森胃底折叠术（50%对0%；P = 0.01）的死亡率有统计学显著增加。总体而言，91例再次手术（85%）是针对原手术部位发生的并发症，包括与吻合口相关的并发症（n = 16）、手术伤口（n = 21）、感染（n = 16）、出血（n = 12）和其他并发症（n = 26）。
非计划重返手术室发生在广泛的普通外科手术中，具有重要意义。由于它们大多反映与手术本身相关的问题，再次手术率可能有助于监测各医院的质量，并识别当地质量改进的机会。
