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Mege D, Sabbagh C, Deleuze A, Gugenheim J, Millat B, Fabre JM, Borie F. Unplanned surgery after colorectal resection: laparoscopy at the index surgery is a protective factor against mortality. Surg Endosc 2023; 37:7100-7105. [PMID: 37395805 DOI: 10.1007/s00464-023-10227-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 06/17/2023] [Indexed: 07/04/2023]
Abstract
BACKGROUND The aim of this study was to assess risk factors of mortality after unplanned surgery following colorectal resection. METHODS All the consecutive patients who underwent colorectal resection between 2011 and 2020 in a French national cohort were retrospectively included. Perioperative data of the index colorectal resection (indication, surgical approach, pathological analysis, postoperative morbidity), and characteristics of unplanned surgery (indication, time to complication, time to surgical redo) were assessed in order to identify predictive factors of mortality. RESULTS Among 547 included patients, 54 patients died (10%; 32 men; mean age = 68 ± 18 years, range 34-94 years). Patients who died were significantly older (75 ± 11 vs 66 ± 12 years, p = 0.002), frailer (ASA score 3-4 = 65 vs 25%, p = 0.0001), initially operated through open approach (78 vs 41%, p = 0.0001), and without any anastomosis (17 vs 5%, p = 0.003) than those alive. The presence of colorectal cancer, the time to postoperative complication and the time to unplanned surgery were not significantly associated to the postoperative mortality. After multivariate analysis, 5 independent predictive factors of mortality were identified: old age (OR 1.038; IC 95% 1.006-1.072; p = 0.02), ASA score = 3 (OR 5.9, CI95% 1.2-28.5, p = 0.03), ASA score = 4 (OR 9.6; IC95% 1.5-63; p = 0.02), open approach for the index surgery (OR 2.7; IC95% 1.3-5.7; p = 0.01), and delayed management (OR 2.6; IC95% 1.3-5.3; p = 0.009). CONCLUSION After unplanned surgery following colorectal surgery, one out of 10 patients dies. The laparoscopic approach during the index surgery is associated with a good prognosis in the case of unplanned surgery.
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Affiliation(s)
- Diane Mege
- Aix Marseille Univ, APHM, Department of Digestive Surgery, Timone University Hospital, 264 Rue Saint-Pierre, 13005, Marseille, France.
| | - Charles Sabbagh
- Service de Chirurgie Digestive, CHU Amiens Picardie et Université de Picardie Jules Verne, Amiens, France
| | - Alain Deleuze
- Fédération de Chirurgie Viscérale et Digestive (FCVD), 12 Rue Bayard, 31000, Toulouse, France
| | - Jean Gugenheim
- Department of Bariatric Surgery, Hospital Archet 2, Nice, France
| | - Bertrand Millat
- Department of Digestive Surgery, Montpellier University Hospital, Montpellier, France
| | - Jean-Michel Fabre
- Department of Digestive Surgery, Montpellier University Hospital, Montpellier, France
| | - Frederic Borie
- Fédération de Chirurgie Viscérale et Digestive (FCVD), 12 Rue Bayard, 31000, Toulouse, France
- Department of Digestive Surgery, Carémeau Hospital, University of Montpellier, Nîmes, France
- Research Unit INSERM University of Montpellier, IDESP Institute Desbrest of Epidemiology and Public Health, Montpellier, France
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Mei LY, Feng YG, Tao SL, Jiang B, Dai FQ, Zhou JH, Shen C, Guo W, Tan QY, Deng B. Analysis of the unplanned reoperation following surgical treatment of pulmonary tumor. J Cardiothorac Surg 2022; 17:306. [PMID: 36510224 PMCID: PMC9746151 DOI: 10.1186/s13019-022-02064-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 12/07/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND In this study, we aimed to summarize the extremely important lesson and experience in the whole process of surgical treatments of lung tumors for the benefit of steps taken to prevent against unplanned reoperation. METHODS Demographical and clinical information of 7732 patients were retrospectively retrieved and reviewed, who were diagnosed with pulmonary tumor and underwent surgical treatments from January 2016 to March 2021. Those patients who underwent unplanned reoperation for the treatment of severe complications were focused carefully and analyzed meticulously. RESULTS A total of forty-one patients (41/7732) received 44 unplanned reoperations. Among them, eight and thirty-three patients were diagnosed with benign and malignant tumor, respectively. The incidence of unplanned reoperations seemed to be similar on both sides (Left vs. Right: 12/3231 vs. 29/4501, p = 0.103). Lobectomy plus segmentectomy is prone to reoperation (2/16, 12.5%) as compared to the other types of surgery. The complications leading to reoperation was hemothorax, including active hemorrhage (23/44, 52.3%) and clotted hemothorax (6/44, 13.6%), chylothorax (8/44, 18.2%), and the others (7/44, 15.9%) including bronchopleural fistula, torsion, or injury of right middle bronchus and pulmonary bulla rupture. The morbidity and mortality after unplanned reoperation were 17.1% (7/41) and 12.2% (5/41), respectively. CONCLUSIONS Bronchi or vessel stumps, the surgical edges of the lung parenchyma, and pleural adhesions should be checked to avoid postoperative bleeding. Prophylactic ligation of the thoracic duct should be recommended in case of the suspected oily-like exudation in the lymph node bed. Smooth expansion of the middle lobe is important to avoid narrowing and torsion before transection of the bronchus.
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Affiliation(s)
- Long-Yong Mei
- grid.414048.d0000 0004 1799 2720Thoracic Surgery Department, Institute of Surgery Research, Daping Hospital, Army Medical University, Changjiang Branch St,10#, Yuzhong District, Chongqing City, 400042 China
| | - Yong-Geng Feng
- grid.414048.d0000 0004 1799 2720Thoracic Surgery Department, Institute of Surgery Research, Daping Hospital, Army Medical University, Changjiang Branch St,10#, Yuzhong District, Chongqing City, 400042 China
| | - Shao-Lin Tao
- grid.414048.d0000 0004 1799 2720Thoracic Surgery Department, Institute of Surgery Research, Daping Hospital, Army Medical University, Changjiang Branch St,10#, Yuzhong District, Chongqing City, 400042 China
| | - Bin Jiang
- grid.414048.d0000 0004 1799 2720Thoracic Surgery Department, Institute of Surgery Research, Daping Hospital, Army Medical University, Changjiang Branch St,10#, Yuzhong District, Chongqing City, 400042 China
| | - Fu-Qiang Dai
- grid.414048.d0000 0004 1799 2720Thoracic Surgery Department, Institute of Surgery Research, Daping Hospital, Army Medical University, Changjiang Branch St,10#, Yuzhong District, Chongqing City, 400042 China
| | - Jing-Hai Zhou
- grid.414048.d0000 0004 1799 2720Thoracic Surgery Department, Institute of Surgery Research, Daping Hospital, Army Medical University, Changjiang Branch St,10#, Yuzhong District, Chongqing City, 400042 China
| | - Cheng Shen
- grid.414048.d0000 0004 1799 2720Thoracic Surgery Department, Institute of Surgery Research, Daping Hospital, Army Medical University, Changjiang Branch St,10#, Yuzhong District, Chongqing City, 400042 China
| | - Wei Guo
- grid.414048.d0000 0004 1799 2720Thoracic Surgery Department, Institute of Surgery Research, Daping Hospital, Army Medical University, Changjiang Branch St,10#, Yuzhong District, Chongqing City, 400042 China
| | - Qun-You Tan
- grid.414048.d0000 0004 1799 2720Thoracic Surgery Department, Institute of Surgery Research, Daping Hospital, Army Medical University, Changjiang Branch St,10#, Yuzhong District, Chongqing City, 400042 China
| | - Bo Deng
- grid.414048.d0000 0004 1799 2720Thoracic Surgery Department, Institute of Surgery Research, Daping Hospital, Army Medical University, Changjiang Branch St,10#, Yuzhong District, Chongqing City, 400042 China
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Petrella F, Casiraghi M, Radice D, Bardoni C, Cara A, Mohamed S, Sances D, Spaggiari L. Unplanned Return to the Operating Room after Elective Oncologic Thoracic Surgery: A Further Quality Indicator in Surgical Oncology. Cancers (Basel) 2022; 14:cancers14092064. [PMID: 35565193 PMCID: PMC9104285 DOI: 10.3390/cancers14092064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 04/13/2022] [Accepted: 04/18/2022] [Indexed: 01/25/2023] Open
Abstract
Background: An unplanned return to the operating room (UROR) is defined as a readmission to the operating room because of a complication or an untoward outcome related to the initial surgery. The aim of the present report is to evaluate the role of URORs after elective oncologic thoracic surgery. Methods: In the study, 4012 consecutive patients were enrolled; among them, 71 patients (1.76%) had an unplanned return to the operating room. Age, sex, Charlson comorbidity index, induction treatments, type of the first operation, indication to readmission to the operating room and type of second operation, length of stay, complication after reoperation and outcomes were collected. Results: The mean age was 63.3 (SD: 13.0); there were 53 male patients (74.6%); the type of the first procedure was: lower lobectomy (11.3%), middle lobectomy (1.4%), upper lobectomy (22.5%), metastasectomy (5.6%), extrapleural pneumonectomy (4.2%), pneumonectomy (40.9%), pleural biopsy (5.6%) and other procedures (8.5%). Patients presenting complications after UROR had undergone a significantly longer first procedure (p < 0.02), had a longer length of stay (p < 0.001) and had higher post-operative mortality (p < 0.001). Conclusions: The patients experiencing UROR after elective oncologic thoracic surgery have significantly higher morbidity and mortality rates when compared to standard thoracic surgery. Bronchopleural fistula remains the most lethal complication in patients undergoing UROR.
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Affiliation(s)
- Francesco Petrella
- Department of Thoracic Surgery, IRCCS European Institute of Oncology, 20141 Milan, Italy; (M.C.); (C.B.); (A.C.); (S.M.); (L.S.)
- Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, 20122 Milan, Italy
- Correspondence: or ; Tel.: +39-0257489362; Fax: +39-0294379218
| | - Monica Casiraghi
- Department of Thoracic Surgery, IRCCS European Institute of Oncology, 20141 Milan, Italy; (M.C.); (C.B.); (A.C.); (S.M.); (L.S.)
| | - Davide Radice
- Division of Epidemiology and Biostatistics, IRCCS European Institute of Oncology, 20141 Milan, Italy;
| | - Claudia Bardoni
- Department of Thoracic Surgery, IRCCS European Institute of Oncology, 20141 Milan, Italy; (M.C.); (C.B.); (A.C.); (S.M.); (L.S.)
| | - Andrea Cara
- Department of Thoracic Surgery, IRCCS European Institute of Oncology, 20141 Milan, Italy; (M.C.); (C.B.); (A.C.); (S.M.); (L.S.)
| | - Shehab Mohamed
- Department of Thoracic Surgery, IRCCS European Institute of Oncology, 20141 Milan, Italy; (M.C.); (C.B.); (A.C.); (S.M.); (L.S.)
| | - Daniele Sances
- Division of Anesthesiology, IRCCS European Institute of Oncology, 20141 Milan, Italy;
| | - Lorenzo Spaggiari
- Department of Thoracic Surgery, IRCCS European Institute of Oncology, 20141 Milan, Italy; (M.C.); (C.B.); (A.C.); (S.M.); (L.S.)
- Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, 20122 Milan, Italy
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Li J, Xue Q, Gao Y, Mao Y, Zhao J, Gao S. Bleeding is the most common cause of unplanned return to operating room after lung cancer surgeries. J Thorac Dis 2020; 12:7266-7271. [PMID: 33447415 PMCID: PMC7797821 DOI: 10.21037/jtd-20-2651] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background The rate of unplanned return to the operation room (UROR) is an important index for the quality of surgeries. Study of the features and causes of patients who have suffered UROR is key to reduce the risk of it. Methods A retrospective, observational study was conducted among lung cancer patients who have received lung resections and UROR over a 5-year period. The causes, findings, procedures of UROR and recovery of patients were examined. Results Among the 23,345 lung cancer surgeries, 64 underwent UROR with the rate being 0.27%. Lobectomy was performed in 78.1% of the patients. The most common indication was post-operative bleeding, responsible for 82.8% (53/64) of the cases. The median length of stay after the second surgery was 7 days and over 90% of the patients were discharged with proper recovery. The death rate within 90 days after return to operation room (OR) was 1.6% (1/64). In the 53 cases caused by bleeding, 27 (50.9%) occurred in surgical sites, with the raw surface of lymph node dissection being most frequently affected. Bleedings on incisions and unknown origin took up 11.3% and 37.7%, respectively. Conclusions Bleeding is the most common indication which causes over 80% of UROR for lung cancer surgeries. Careful examination and complete hemostasis in surgery is key to reduce the risk of this unwanted complication.
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Affiliation(s)
- Jiagen Li
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qi Xue
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yushun Gao
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yousheng Mao
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jun Zhao
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shugeng Gao
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Adams OE, Cruz SA, Balach T, Dirschl DR, Shi LL, Lee MJ. Do 30-Day Reoperation Rates Adequately Measure Quality in Orthopedic Surgery? Jt Comm J Qual Patient Saf 2020; 46:72-80. [PMID: 31899155 DOI: 10.1016/j.jcjq.2019.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Revised: 11/12/2019] [Accepted: 11/13/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Unplanned reoperation rates represent an important metric in monitoring quality in orthopedic surgery. Previous studies have focused on 30-day reoperation rates, not accounting for complications that may arise beyond this time. This study aimed to understand the frequency, timing, and procedure type of orthopedic reoperations, as well as the complications leading up to these reoperations over a 1-year period. METHODS A single-center, retrospective cohort study reviewed all orthopedic surgeries performed within a three-year period and subsequently identified reoperations within a year following the initial case. Exclusion criteria for reoperations included those that were planned, involved a different body part, or had a different laterality from the first operation. The cases were analyzed by procedure type, timing of reoperation, and causes of reoperation. RESULTS Of the 10,449 orthopedic surgeries performed between 2012 and 2015, 947 (9.1%) were unplanned reoperations within 1 year. Most (775; 81.8%) unplanned reoperations occurred after 30 days. Infections/wound complications (58.2%) were the most common reason for unplanned reoperations at 1 month from the initial operation, and mechanical complications (49.5%) predominated at the 6-months-to-1-year time frame. CONCLUSION This study demonstrated that the current paradigm of focusing on reoperations occurring within 30 days of the initial operation captures only a fraction of unplanned reoperations. Stratification of this metric by time and precipitating complication type provides additional information that quality improvement programs may target. A 1-year unplanned reoperation rate could be used as a broad indicator of surgical quality across institutions.
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Sparreboom CL, Lambrichts DPV, Menon AG, Kleinrensink GJ, Lingsma HF, Lange JF. Outcomes After Elective Colorectal Surgery by 2 Surgeons Versus 1 Surgeon in a Low-Volume Hospital. Surg Innov 2019; 26:753-759. [PMID: 31394977 DOI: 10.1177/1553350619868109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background. Improved patient outcomes after colorectal surgery in high-volume hospitals are leading to centralization of colorectal surgery. However, it is desirable to strive for optimal quality of colorectal surgery in low-volume hospitals. This study aimed to assess the effect of the number of surgeons involved in the surgical procedure on patient outcomes in a low-volume hospital. Methods. All patients who underwent elective colorectal surgery with construction of a primary anastomosis between January 1, 2007, and December 31, 2015, were included in this retrospective cohort. The propensity score was used to adjust for confounding. Results. A total of 429 patients were included. One hundred forty-three patients (33.3%) were operated by 1 surgeon and 286 patients (66.7%) were operated by 2 surgeons. Patients operated by 2 surgeons were younger, more often male, and had a higher body mass index. A multivariate analysis with propensity scores revealed that surgery with 2 surgeons was associated with fewer reoperations (odds ratio [OR] = 0.4, 95% confidence interval [CI] = 0.2-0.9, P = .038). Colorectal anastomotic leakage (OR = 0.6, 95% CI = 0.2-1.3, P = .204) and mortality (OR = 0.8, 95% CI = 0.2-3.7, P = .807) were not associated with the number of surgeons involved in the surgical procedure. Conclusion. The present study shows that elective colorectal surgery in a low-volume hospital performed by 2 surgeons resulted in fewer reoperations. This might positively influence patient outcomes and might be related to increased surgical quality as compared with procedures performed by only 1 surgeon.
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Affiliation(s)
| | | | - Anand G Menon
- Erasmus University Medical Center, Rotterdam, Netherlands.,Havenziekenhuis, Rotterdam, Netherlands.,IJsselland ziekenhuis, Capelle aan den IJssel, Netherlands
| | | | | | - Johan F Lange
- Erasmus University Medical Center, Rotterdam, Netherlands.,Havenziekenhuis, Rotterdam, Netherlands.,IJsselland ziekenhuis, Capelle aan den IJssel, Netherlands
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Kerezoudis P, Glasgow AE, Alvi MA, Spinner RJ, Meyer FB, Bydon M, Habermann EB. Returns to Operating Room After Neurosurgical Procedures in a Tertiary Care Academic Medical Center: Implications for Health Care Policy and Quality Improvement. Neurosurgery 2019; 84:E392-E401. [PMID: 30299515 DOI: 10.1093/neuros/nyy429] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 08/10/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Return to the operating room (ROR) has been put forth by the National Quality Forum and the American College of Surgeons as a surgical quality indicator. However, current quality metrics fail to consider the nature and etiology of the ROR. OBJECTIVE To provide a comprehensive description of all reoperations after neurosurgical procedures and assess the validity of ROR as a quality measure in neurosurgery. METHODS We retrospectively analyzed all neurosurgical procedures performed in a high-volume, tertiary care academic medical center between June 1, 2014 and December 31, 2016. Based on a system constructed and validated at our institution, we classified RORs into (a) unplanned related, (b) planned return due to complications, (c) planned-staged return, or (d) unrelated return. RESULTS A total of 9200 unique neurosurgical cases were identified, of which 788 had an ROR within 45 d (8.6%). Median time to ROR (interquartile range) was 9 d (4-15). Specifically, 4.2% were planned-staged returns, 3.4% were unplanned related, 0.3% were unrelated, and 0.6% were planned because of previous complications. Cranial procedures had the highest unplanned ROR rate (4.2%), followed by spinal (2.8%) and peripheral nerve (0.4%). The most common reason for an unplanned ROR was wound complication/surgical site infection (34.3%), followed by hematoma evacuation (13.9%) and cerebrospinal fluid (CSF) leak (11.3%). CONCLUSION Unplanned RORs were relatively rare and most commonly associated with wound complication, postoperative hematoma, and CSF leak. To better reflect surgical quality, ROR metrics should indicate whether the return was planned or unrelated.
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Affiliation(s)
- Panagiotis Kerezoudis
- Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Amy E Glasgow
- Surgical Outcomes Program, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | - Mohammed Ali Alvi
- Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Robert J Spinner
- Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Fredric B Meyer
- Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Mohamad Bydon
- Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota
| | - Elizabeth B Habermann
- Surgical Outcomes Program, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
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Richardson AJ, Cox MR, Shakeshaft AJ, Hodge B, Morgan G, Pang T, Zeng M, Scanlon K, Austin R, Dawadi A, Burgess C, Rawstron E, Dalton S, Leveque J. Quality improvement in surgery: introduction of the American College of Surgeons National Surgical Quality Improvement Program into New South Wales. ANZ J Surg 2019; 89:471-475. [DOI: 10.1111/ans.15117] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 01/14/2019] [Accepted: 01/15/2019] [Indexed: 12/29/2022]
Affiliation(s)
- Arthur J. Richardson
- Department of SurgeryWestmead Hospital Sydney New South Wales Australia
- The University of Sydney Sydney New South Wales Australia
| | - Michael R. Cox
- The University of Sydney Sydney New South Wales Australia
- Department of SurgeryNepean Hospital Sydney New South Wales Australia
| | | | - Bruce Hodge
- Department of SurgeryPort Macquarie Hospital Port Macquarie New South Wales Australia
| | - Gary Morgan
- Department of SurgeryWestmead Hospital Sydney New South Wales Australia
| | - Tony Pang
- Department of SurgeryWestmead Hospital Sydney New South Wales Australia
- The University of Sydney Sydney New South Wales Australia
| | - Mingjuan Zeng
- Department of SurgeryWestmead Hospital Sydney New South Wales Australia
| | - Kate Scanlon
- Department of SurgeryNepean Hospital Sydney New South Wales Australia
| | - Robyn Austin
- Department of SurgeryPort Macquarie Hospital Port Macquarie New South Wales Australia
| | - Ashma Dawadi
- Department of SurgeryCoffs Harbour Hospital Coffs Harbour New South Wales Australia
| | - Crystal Burgess
- Agency for Clinical InnovationNSW Ministry of Health Sydney New South Wales Australia
| | - Ellen Rawstron
- Agency for Clinical InnovationNSW Ministry of Health Sydney New South Wales Australia
| | - Sarah Dalton
- Agency for Clinical InnovationNSW Ministry of Health Sydney New South Wales Australia
| | - Jean‐Frederic Leveque
- Agency for Clinical InnovationNSW Ministry of Health Sydney New South Wales Australia
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Murphy BL, Glasgow AE, Habermann EB, Hieken TJ. Returns to the operating room after breast surgery at a tertiary care medical center. Am J Surg 2019; 218:388-392. [PMID: 30824169 DOI: 10.1016/j.amjsurg.2019.02.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 02/07/2019] [Accepted: 02/18/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Evaluation of returns to the operating room (RORs) may spur practice modifications to improve patient outcomes and hospital practices. We determined the frequency and indications for RORs after breast operations. METHODS We identified patients ≥18 years who underwent a breast operation at our institution 1/1/14-1/13/17 and assessed ROR within 45-days. RORs were categorized as unplanned/planned, staged/unstaged, or unrelated procedures. Univariate and multivariable analyses compared variables between patients who did and did not have an ROR. RESULTS 2,914 patients underwent a breast operation of whom 117 (4.0%) had 121 RORs. Planned staged procedures accounted for 48 RORs (39.7%), while unplanned complications accounted for 65 (53.7%). On multivariable analysis, ROR was more common among patients undergoing total, skin-sparing, or nipple-sparing mastectomy (versus lumpectomy) all p < 0.03, while immediate breast reconstruction did not increase RORs. CONCLUSIONS RORs following breast operations occurred in 4% of patients, with approximately one-third for a staged oncologic procedure. Implementation of ROR documentation tools should be encouraged, as these data provide benchmarks for clinical practice improvement initiatives to improve the quality of patient care.
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Affiliation(s)
- Brittany L Murphy
- Departments of Surgery, Mayo Clinic, Rochester, MN, USA; The Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery Surgical Outcomes Program, Mayo Clinic, Rochester, MN, USA
| | - Amy E Glasgow
- The Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery Surgical Outcomes Program, Mayo Clinic, Rochester, MN, USA
| | - Elizabeth B Habermann
- Departments of Surgery, Mayo Clinic, Rochester, MN, USA; The Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery Surgical Outcomes Program, Mayo Clinic, Rochester, MN, USA
| | - Tina J Hieken
- Departments of Surgery, Mayo Clinic, Rochester, MN, USA.
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Lyon TD, Boorjian SA, Shah PH, Tarrell R, Cheville JC, Frank I, Karnes RJ, Thompson RH, Tollefson MK. Comprehensive characterization of perioperative reoperation following radical cystectomy. Urol Oncol 2019; 37:292.e11-292.e17. [PMID: 30679081 DOI: 10.1016/j.urolonc.2018.11.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Revised: 11/06/2018] [Accepted: 11/27/2018] [Indexed: 11/18/2022]
Abstract
INTRODUCTION To examine the nature, timing, and risk factors underlying return to the operating room (ROR) following radical cystectomy (RC). ROR has been proposed as a surgical quality metric based on data from the general surgery literature, but ROR has not been comprehensively characterized following RC. PATIENTS AND METHODS We queried our institutional Cystectomy Registry from 2000 to 2016 to identify patients with ROR within 90 days of RC. Multivariable logistic regression was used to examine associations between patient features and ROR. Survival outcomes were studied based on whether ROR was necessary. RESULTS Of 1968 patients treated with RC, 112 (5.7%) underwent 125 reoperations within 90 days of RC, of which 93% were unanticipated and due to postsurgical complications. The most common reasons for ROR were facial dehiscence (29%), bowel obstruction (21%), and enteric anastomotic leak (8%). On multivariable analysis, increasing body mass index (odds ratio 1.04, 95% confidence interval (CI) 1.01-1.08, P = 0.045) and albumin <3.5 g/dl (odds ratio 2.15, 95% CI 1.28-3.59, P = 0.004) were associated with greater odds of ROR. Patients with a ROR had significantly decreased 5-year overall survival compared to patients who did not undergo ROR (43% vs. 55%; P = 0.003), and ROR was associated with increased all-cause mortality after multivariable adjustment (hazard ratio 1.33, 95% CI 1.01-1.74, P = 0.04). CONCLUSION ROR principally occurred due to unanticipated complications and was associated with increased mortality after RC. These data suggest ROR may be a useful metric by which urological programs can track the efficacy of interventions aimed at improving perioperative care for RC patients.
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Affiliation(s)
| | | | - Paras H Shah
- Department of Urology, Mayo Clinic, Rochester, MN
| | - Robert Tarrell
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - John C Cheville
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Igor Frank
- Department of Urology, Mayo Clinic, Rochester, MN
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