Do 30-Day Reoperation Rates Adequately Measure Quality in Orthopedic Surgery?

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.

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.

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.

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.