Cima Robert R, Dhanorker Sarah R, Ostendorf Christopher L, Ntekpe Mfonabasi, Mudundi Raghu V, Habermann Elizabeth B, Deschamps Claude
Jt Comm J Qual Patient Saf. 2017 Mar;43(3):138-145. doi: 10.1016/j.jcjq.2016.11.003. Epub 2016 Nov 14.
The metric "Unplanned returns to operating room (ROR)" is being tracked in surgical quality dashboards; 70% of unplanned RORs may be related to surgical complications. With increasing regionalization of trauma and complex surgical care at tertiary care academic centers, it is unclear if a simple ROR metric is a valid assessment of surgical quality at such centers.
A real-time electronic tool was used to identify all RORs-planned and unplanned-in a high-volume, high-complexity academic surgical practice at Mayo Clinic-Rochester within 45 days of the index operation. Analysis by ROR type and indication was performed.
During the analysis period (June 2014-February 2015) 44,031 operations were performed, with 5,552 subsequent RORs (13%). Of all RORs, 51% (n = 2,818) were planned staged returns, 29% (n = 1,589) were unrelated, 15% (n = 830) were unplanned and 6% (n = 315) were planned because of previous complications. Overall, unplanned reoperations were uncommon (n = 830, 2% of all operations). The most common indications for unplanned RORs included "other" (32%, n = 266), bleeding related (24%, n = 198) and wound complications (20%, n = 166).
In a high-volume, high-complexity academic surgical practice, RORs occurred after 13% of cases. Unplanned returns were infrequent and usually were associated with complications; most RORs were planned staged or unrelated returns. A simple ROR metric that does not consider planned/unrelated returns is likely not a valid surgical quality measure. Electronic tools designed specifically to identify in real-time RORs, associated indication, and clinical validation should provide more reliable data for public reporting and quality improvement efforts.
“非计划重返手术室（ROR）”这一指标正在手术质量仪表盘上进行跟踪；70%的非计划ROR可能与手术并发症有关。随着三级医疗学术中心创伤和复杂手术护理区域化程度的提高，尚不清楚简单的ROR指标是否是对此类中心手术质量的有效评估。
使用一种实时电子工具，在梅奥诊所 - 罗切斯特分院的高容量、高复杂性学术外科手术实践中，识别索引手术45天内所有计划内和非计划内的ROR。按ROR类型和指征进行分析。
在分析期间（2014年6月 - 2015年2月），共进行了44,031例手术，随后有5,552例ROR（13%）。在所有ROR中，51%（n = 2,818）为计划内分期重返，29%（n = 1,589）无关，15%（n = 830）为非计划内，6%（n = 315）因先前并发症而计划内。总体而言，非计划再次手术并不常见（n = 830，占所有手术的2%）。非计划ROR最常见的指征包括“其他”（32%，n = 266）、出血相关（24%，n = 198）和伤口并发症（20%，n = 166）。
在高容量、高复杂性学术外科手术实践中，13%的病例术后出现ROR。非计划重返很少见，通常与并发症相关；大多数ROR是计划内分期或无关重返。不考虑计划内/无关重返的简单ROR指标可能不是有效的手术质量衡量标准。专门设计用于实时识别ROR、相关指征和临床验证的电子工具应为公共报告和质量改进工作提供更可靠的数据。
