title: Unplanned return to the operating theatre in gynaecology: five years' experience.
abstract: OBJECTIVE
  To review our incidence of unplanned return to the operating theatre (OT) and compare our findings with the published literature.
  
  
  METHODS
  Five year retrospective review of case notes in our gynaecology department between January 2005 and April 2010. Women were eligible for recruitment if they returned to the OT for an unplanned operation during the same admission following a gynaecological operation.
  
  
  RESULTS
  Seventeen cases were identified, mean age 40 years (range 27-52 years). The incidence of unplanned return to the OT was 0.03%. Elective and emergency initial operations accounted for 72% and 28% respectively. Over 80% of the cases followed a hysterectomy, giving an overall risk of return to OT after hysterectomy of 2%. Reactionary bleeding was the cause in all cases. A specific bleeding site was identified in 82% of the women. The mean time between primary surgery and return to the OT was 7.9 h. The triggering factors were a combination of a change in observations, postoperative bleeding, a drop in haemoglobin level and uncontrolled abdominal pain despite analgesics. Blood transfusion was required in 53% of cases and one woman was admitted to the intensive care unit for one night. No women required further reoperation, and all were discharged home with no long-term sequelae.
  
  
  CONCLUSIONS
  Unplanned reoperation is a potentially life threatening complication, and therefore early recognition; resuscitation and emergency return to the OT to stop the bleeding are the main principles of management.
authors.affiliation: Department of Obstetrics and Gynaecology, North Hampshire hospital, Aldermaston Road, Basingstoke, RG24 9NA, Hampshire, United Kingdom. ismaiel_khr@yahoo.com
authors.forename: Ismaiel
authors.initials: I
authors.lastname: Mahfouz
authors.forename: Fida
authors.initials: F
authors.lastname: Asali
authors.forename: Rebecca
authors.initials: R
authors.lastname: Wiltshire
authors.forename: Timothy R
authors.initials: TR
authors.lastname: Sayer
authors.forename: Christian H
authors.initials: CH
authors.lastname: Phillips
mesh_terms: D015746:Abdominal Pain / Q000453:epidemiology / Q000209:etiology; D000328:Adult; D001803:Blood Transfusion; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects*; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects; D015994:Incidence; D008875:Middle Aged; D009873:Operating Rooms / Q000706:statistics & numerical data*; D019106:Postoperative Hemorrhage / Q000453:epidemiology* / Q000209:etiology* / Q000628:therapy; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013997:Time Factors; D006113:United Kingdom