An institutional analysis of unplanned return to the operating room to identify areas for quality improvement

- A chart review was performed to identify causes of unplanned return to the operating room (uROR) at our institution.
- The most common reasons for unplanned return were infection and hemorrhage.
- A large number of cases were incorrectly classified as uROR, but were in fact planned reoperations without adequate documentation.
- This raises concerns for using NSQIP-identified uROR as a hospital quality metric.

BackgroundUnplanned return to the operating room (uROR) has been suggested as a hospital quality indicator. The purpose of this study was to determine reasons for uROR to identify opportunities for patient care improvement.MethodsuROR reported by our institution's American College of Surgeons National Surgical Quality Improvement Program underwent secondary review.ResultsThe uROR rate reported by clinical reviewers was 4.3%. Secondary review re-categorized 64.7% as “true uROR” with the most common reasons for uROR being infection (30.9%) and bleeding (23.6%). Remaining cases were categorized as “false uROR” with the most common reasons being inadequate documentation (60.0%) and not directly related to index procedure (16.7%).ConclusionsStrict adherence to NSQIP definitions results in misidentification of true uROR. This raises concerns for using NSQIP-identified uROR as a hospital quality metric. Improved processes of care to prevent infection and hemorrhage at our institution could reduce the rate of true uROR.