Returns to Operating Room After Colon and Rectal Surgery in a Tertiary Care Academic Medical Center: a Valid Measure of Surgical Quality?
INTRODUCTION
Returns to the operating room (ROR) have been suggested as a marker of surgical quality. Increasingly, quality and value metrics are utilized for reimbursement as well as public reporting to inform health care consumers. We sought to understand the etiology of ROR and assess the validity of simple ROR as a quality metric.


METHODS
This was a single referral center retrospective review of all colon and rectal operations between January 1, 2014 and December 31, 2014. Surgical Systems Nurse + was constructed and validated at our institution for classifying ROR as either an unplanned return to the OR, planned return due to complications, planned staged return, or an unrelated return. The primary outcome was the classification of ROR and total number of ROR within 30 days.


RESULTS
Of the 2389 colorectal patients who underwent surgery between January 1, 2014 and December 31, 2014; 214 returned to the operating room within 30 days (9.0%). Among the 214 patients, there were a total of 232 ROR with an average of 1.1 ROR per patient (range 1-4); 90 (38.8%) were unplanned ROR, 49 (21.1%) were planned returns due to complications, 92 (39.7%) were planned staged returns, and 1 (0.4%) were unrelated ROR. The most common reason for an unplanned ROR was an anastomotic leak (n = 21; 9.1%). Overall, unplanned reoperations were rare events (n = 90/2389; 3.8%), largely comprised of patients experiencing an anastomotic abscess or leak (n=21/2389; 0.9%).


CONCLUSIONS
In a high volume and complexity academic colon and rectal surgery practice, RORs within 30 days occurred after 10.4% of cases. Unplanned ROR were relatively rare and most commonly associated with an anastomotic leak. Since the majority of ROR were planned-staged returns, overall rate of ROR should be questioned as a metric of surgical quality. Perhaps, the anastomotic leak rate may be a better metric to monitor for quality improvement efforts.
['Lightner|Amy L|AL|', 'Glasgow|Amy E|AE|', 'Habermann|Elizabeth B|EB|', 'Cima|Robert R|RR|']
D000046:Academic Medical Centers D000293:Adolescent D000328:Adult D000368:Aged D057868:Anastomotic Leak D003106:Colon D003627:Data Interpretation, Statistical D013505:Digestive System Surgical Procedures D005260:Female D006801:Humans D008297:Male D008875:Middle Aged D019984:Quality Indicators, Health Care D012007:Rectum D012086:Reoperation D012189:Retrospective Studies D062606:Tertiary Care Centers D055815:Young Adult
Return to operating room Colon and rectal surgery Surgical quality