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Related Experiment Videos

Reoperations within 48 hours following 7942 pediatric neurosurgery procedures.

Anil K Roy1, Jason Chu1, Caroline Bozeman2

  • 1Department of Neurosurgery, Emory University School of Medicine; and.

Journal of Neurosurgery. Pediatrics
|April 1, 2017
PubMed
Summary

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Pediatric neurosurgery reoperations within 48 hours occurred at a 2.78% rate. Unplanned reoperations were linked to after-hours surgery and emergency department admissions, suggesting system and surgeon factors.

Area of Science:

  • Pediatric Neurosurgery
  • Surgical Quality Indicators
  • Healthcare Systems Analysis

Background:

  • Early reoperation rate is a key indicator for surgical care quality.
  • Data on indications and rates of 48-hour reoperations in pediatric neurosurgery are limited.

Purpose of the Study:

  • To report the indications and rate of reoperations within 48 hours in pediatric neurosurgery.
  • To identify risk factors associated with unplanned early reoperations.

Main Methods:

  • Prospective data collection of 7942 pediatric neurosurgeries from 2009-2014.
  • Classification of procedures into 31 categories.
  • Multivariate logistic regression to analyze risk factors for unplanned reoperations.

Main Results:

Keywords:
ACGME = Accreditation Council for Graduate Medical EducationED = emergency departmentEVD = external ventricular drainICP = intracranial pressureICU = intensive care unitLP = lumboperitonealNICU = neonatal ICUSP/CP = subdural-peritoneal/cyst peritonealVA = ventriculoatrialVAD = ventricular access deviceVP = ventriculoperitonealpediatric neurosurgeryquality assurancereoperation

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  • Overall 48-hour reoperation rate was 2.78% (221/7942).
  • 159 (72%) of reoperations were unplanned, with 121 following shunt manipulations.
  • After-hours surgery (OR 2.01) and emergency department admission (OR 1.97) significantly increased unplanned reoperation likelihood.

Conclusions:

  • Approximately 25% of early reoperations were planned.
  • Unplanned reoperations are influenced by surgeon and system-related factors.
  • Further research is needed to determine preventability and refine the use of unplanned reoperation as a quality metric.