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The Incidence and Causes of Unplanned Reoperations as a Quality Indicator in Pediatric Surgery
Miro Jukić1,2, Ivona Biuk2, Zenon Pogorelić1,2
1Department of Pediatric Surgery, University Hospital of Split, Spinčićeva 1, 21000 Split, Croatia.
Insights
Unplanned reoperations in pediatric surgery serve as a valuable quality indicator. Emergency surgery, male gender, and higher ASA scores in elective cases are key risk factors for these events.
Area of Science:
- Pediatric Surgery
- Surgical Quality Indicators
- Patient Safety
Background:
- Unplanned return to the operating room (uROR) within 30 days post-surgery is a critical metric in pediatric surgery.
- Evaluating uROR provides insights into surgical quality and patient outcomes.
Purpose of the Study:
- To investigate and assess the utility of unplanned return to the operating room (uROR) as a quality indicator in pediatric surgery.
- Identify risk factors associated with uROR in pediatric patients.
Main Methods:
- Retrospective review of pediatric patient records from January 2018 to December 2020.
- Analysis of uROR rates, indications for surgery, complications, and associated factors.
Main Results:
- The incidence of uROR was 0.5% (19/3982 patients).
- uROR was significantly higher in males (73.7%) and following emergency surgeries (4.5 times higher than elective).
- Surgical technique errors were the most common cause (57.9%), with appendectomy being the most frequent procedure leading to uROR.
Conclusions:
- Unplanned reoperations within 30 days are a significant quality indicator in pediatric surgery.
- Emergency surgery, male gender, and ASA score ≥3 are identified risk factors for uROR in elective pediatric surgery.
Background:
Unplanned return to the operating room (uROR) within the 30-day postoperative period can be used as a quality indicator in pediatric surgery. The aim of this study was to investigate and evaluate uROR as a quality indicator.
Methods:
The case records of pediatric patients who underwent reoperation within the 30-day period after primary surgery, from 1 January 2018 to 31 December 2020 were retrospectively reviewed. The primary outcome of the study was the rate of uROR as a quality indicator in pediatric surgery. Secondary outcomes were indications for primary and secondary surgery, types and management of complications, factors that led to uROR, length of hospital stay, duration of surgery and anesthesia, and starting time of surgery.
Results:
A total of 3982 surgical procedures, under general anesthesia, were performed during the three-year study period (2018, n = 1432; 2019, n = 1435; 2020, n = 1115). Elective and emergency surgeries were performed in 3032 (76.1%) and 950 (23.9%) patients, respectively. During the study period 19 (0.5%) pediatric patients, with the median age of 11 years (IQR 3, 16), underwent uROR within the 30-day postoperative period. The uROR incidence was 6 (0.4%), 6 (0.4%), and 7 (0.6%) for years 2018, 2019, and 2020, respectively (p = 0.697). The incidence of uROR was significantly higher in males (n = 14; 73.7%) than in females (n = 5; 26.3%) (p = 0.002). The share of unplanned reoperations in studied period was 4.5 times higher in primarily emergency surgeries compared to primarily elective surgeries (p < 0.001). The difference in incidence was 0.9% (95% CI, 0.4-1.4). Out of children that underwent uROR within the 30-day period after elective procedures, 50% had American Society of Anesthesiologists (ASA) score three or higher (p = 0.016). The most common procedure which led to uROR was appendectomy (n = 5, 26.3%) while the errors in surgical technique were the most common cause for uROR (n = 11, 57.9%).
Conclusion:
Unplanned reoperations within the 30-day period after the initial surgical procedure can be a good quality indicator in pediatric surgery. Risk factors associated with uROR are emergency surgery, male gender, and ASA score ≥3 in elective pediatric surgery.
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