title: Assessing early unplanned reoperations in neurosurgery: opportunities for quality improvement.
abstract: OBJECTIVE
  Review of morbidities and mortality has been the primary method used to assess surgical quality by physicians, hospitals, and oversight agencies. The incidence of reoperation has been proposed as a candidate quality indicator for surgical care. The authors report a comprehensive assessment of reoperations within a neurosurgical department and discuss how such data can be integrated into quality improvement initiatives to optimize value of care delivery.
  
  
  METHODS
  All neurosurgical procedures performed in the main operating room or the outpatient surgery center at the Ronald Reagan UCLA Medical Center and UCLA Santa Monica Medical Center from July 2008 to December 2012 were considered for this study. Interventional radiology and stereotactic radiosurgery procedures were excluded. Early reoperations within 7 days of the index surgery were reviewed and their preventability status was evaluated.
  
  
  RESULTS
  The incidence of early unplanned reoperation was 2.6% (occurring after 183 of 6912 procedures). More than half of the patients who underwent early unplanned reoperation initially had surgery for shunt-related conditions (34.4%) or intracranial tumor (23.5%). Shunt failure was the most common indication for early unplanned reoperation (34.4%), followed by postoperative bleeding (20.8%) and postoperative elevated intracranial pressure (9.8%). The average time interval (± SD) between the index surgery and reoperation was 3.0 ± 1.9 days. The average length of stay following reoperation was 12.1 ± 14.4 days.
  
  
  CONCLUSIONS
  This study enabled an in-depth assessment of reoperations within an academic neurosurgical practice and identification of strategic opportunities for department-wide quality improvement initiatives. The authors provide a nuanced discussion regarding the use of absolute reoperations as a quality indicator for neurosurgical patient populations.
authors: Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, California; and.
authors: Nancy
authors: N
authors: McLaughlin
authors: Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, California; and.|Department of Neurosurgery, Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China.
authors: Peng
authors: P
authors: Jin
authors: Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, California; and.
authors: Neil A
authors: NA
authors: Martin
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D004868:Equipment Failure; D005260:Female; D006801:Humans; D015994:Incidence; D019586:Intracranial Hypertension / Q000150:complications; D008297:Male; D008875:Middle Aged; D009493:Neurosurgery / Q000706:statistics & numerical data*; D019106:Postoperative Hemorrhage / Q000150:complications; D011785:Quality Assurance, Health Care / Q000592:standards*; D058996:Quality Improvement / Q000592:standards*; D012086:Reoperation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013997:Time Factors; D055815:Young Adult
keywords: ICP = intracranial pressure; LOS = length of stay; OR = operating room; UCLA = University of California, Los Angeles; VP = ventriculoperitoneal; complication; diagnostic and operative techniques; measure; neurosurgery; operating room; quality indicator; reoperation