The risk of an unplanned return to the operating room in Australian hospitals

The unplanned return of the patient to the operating room (OR) after a previous procedure has implications concerning the quality of surgery, but little has been written on this subject.

The relationship of bed-size and hospital type (private or public) was studied using data on this clinical indicator submitted to the Australian Council on Healthcare Standards Care Evaluation Program (ACHS CEP) by hospitals presenting voluntarily for accreditation in 1993.

The mean rate of an unplanned return to OR was 0.6% (95% confidence interval 0.5-0.7). After adjusting for potential confounders in a logistic model, the risk of unplanned return to OR did not significantly differ by type of hospital (private or public), and location (rural, metropolitan). The risk of unplanned return to OR was higher in large compared with small hospitals.

The finding of the risk of the event being greater in large compared with small hospitals is likely to be a reflection of casemix. An interval review of results (for any facility) is obviously necessary. With some operations a higher incidence of return to the OR may indicate vigilance in peri-operative management.