Barksfield R C, Coomber R, Woolf K, Prinja A, Wordsworth D, Lopez D, Burtt S
Luton and Dunstable Hospital NHS Foundation Trust, UK.
Ann R Coll Surg Engl. 2015 Jan;97(1):40-5. doi: 10.1308/003588414X14055925059318.
The Royal College of Surgeons of England (RCS) has issued guidance regarding the use of reoperation rates in the revalidation of UK-based orthopaedic surgeons. Currently, little has been published concerning acceptable rates of reoperation following primary surgical management of orthopaedic trauma, particularly with reference to revalidation.
A retrospective review was conducted of patients undergoing clearly defined reoperations following primary surgical management of trauma between 1 January 2010 and 31 December 2011. A full case note review was undertaken to establish the demographics, clinical course and context of reoperation. A review of the imaging was performed to establish whether the procedure performed was in line with accepted trauma practice and whether the technical execution was acceptable.
A total of 3,688 patients underwent primary procedures within the time period studied while 70 (1.90%, 99% CI: 1.39-2.55) required an unplanned reoperation. Thirty-nine (56%) of these patients were male. The mean age of patients was 56 years (range: 18-98 years) and there was a median time to reoperation of 50 days (IQR: 13-154 days). Potentially avoidable reoperations occurred in 41 patients (58.6%, 99% CI: 43.2-72.6). This was largely due to technical errors (40 patients, 57.1%, 99% CI: 41.8-71.3), representing 1.11% (99% CI: 0.73-1.64) of the total trauma workload. Within RCS guidelines, 28-day reoperation rates for hip, wrist and ankle fractures were 1.4% (99% CI: 0.5-3.3), 3.5% (99% CI: 0.8%-12.1) and 1.86% (99% CI: 0.4-6.6) respectively.
We present novel work that has established baseline reoperation rates for index procedures required for revalidation of orthopaedic surgeons.
英国皇家外科医学院（RCS）已发布关于在英国骨科医生重新认证中使用再次手术率的指南。目前，关于骨科创伤一期手术治疗后可接受的再次手术率，特别是与重新认证相关的内容，鲜有发表。
对2010年1月1日至2011年12月31日期间接受明确界定的创伤一期手术治疗后进行再次手术的患者进行回顾性研究。对完整病历进行审查，以确定再次手术的人口统计学、临床过程和背景。对影像学进行审查，以确定所进行的手术是否符合公认的创伤治疗规范，以及技术操作是否可接受。
在研究期间，共有3688例患者接受了一期手术，其中70例（1.90%，99%可信区间：1.39 - 2.55）需要进行非计划再次手术。这些患者中39例（56%）为男性。患者的平均年龄为56岁（范围：18 - 98岁），再次手术的中位时间为50天（四分位间距：13 - 154天）。41例患者（58.6%，99%可信区间：43.2 - 72.6）发生了潜在可避免的再次手术。这主要是由于技术失误（40例患者，57.1%，99%可信区间：41.8 - 71.3），占创伤总工作量 的1.11%（99%可信区间：0.73 - 1.64）。根据RCS指南，髋部、腕部和踝部骨折的28天再次手术率分别为1.4%（99%可信区间：0.5 - 3.3）、3.5%（99%可信区间：0.
