Lin Yihan, Meguid Robert A, Hosokawa Patrick W, Henderson William G, Hammermeister Karl E, Schulick Richard D, Shelstad Ryan C, Wild Trevor T, McIntyre Robert C
Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA; Surgical Outcomes and Applied Research Program, University of Colorado School of Medicine, Aurora, CO, USA.
Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA; Surgical Outcomes and Applied Research Program, University of Colorado School of Medicine, Aurora, CO, USA.
Am J Surg. 2017 Jul;214(1):1-6. doi: 10.1016/j.amjsurg.2016.10.021. Epub 2016 Dec 13.
Unplanned return to the operating room (uROR) has been suggested as a hospital quality indicator. The purpose of this study was to determine reasons for uROR to identify opportunities for patient care improvement.
uROR reported by our institution's American College of Surgeons National Surgical Quality Improvement Program underwent secondary review.
The uROR rate reported by clinical reviewers was 4.3%. Secondary review re-categorized 64.7% as "true uROR" with the most common reasons for uROR being infection (30.9%) and bleeding (23.6%). Remaining cases were categorized as "false uROR" with the most common reasons being inadequate documentation (60.0%) and not directly related to index procedure (16.7%).
Strict adherence to NSQIP definitions results in misidentification of true uROR. This raises concerns for using NSQIP-identified uROR as a hospital quality metric. Improved processes of care to prevent infection and hemorrhage at our institution could reduce the rate of true uROR.
非计划重返手术室（uROR）已被提议作为一项医院质量指标。本研究的目的是确定非计划重返手术室的原因，以找出改善患者护理的机会。
对我们机构的美国外科医师学会国家外科质量改进计划报告的非计划重返手术室情况进行二次审查。
临床审查人员报告的非计划重返手术室率为4.3%。二次审查将64.7%重新归类为“真正的非计划重返手术室”，非计划重返手术室最常见的原因是感染（30.9%）和出血（23.6%）。其余病例被归类为“假非计划重返手术室”，最常见的原因是记录不充分（60.0%）和与索引手术无直接关系（16.7%）。
严格遵守NSQIP定义会导致对真正的非计划重返手术室的误判。这引发了对将NSQIP确定的非计划重返手术室用作医院质量指标的担忧。在我们机构改进预防感染和出血的护理流程可以降低真正的非计划重返手术室率。
