title: An institutional analysis of unplanned return to the operating room to identify areas for quality improvement.
abstract: BACKGROUND
  Unplanned 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.
  
  
  METHODS
  uROR reported by our institution's American College of Surgeons National Surgical Quality Improvement Program underwent secondary review.
  
  
  RESULTS
  The 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%).
  
  
  CONCLUSIONS
  Strict 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.
authors.affiliation: Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA; Surgical Outcomes and Applied Research Program, University of Colorado School of Medicine, Aurora, CO, USA. Electronic address: yihan.lin@ucdenver.edu.
authors.forename: Yihan
authors.initials: Y
authors.lastname: Lin
authors.affiliation: Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA; Surgical Outcomes and Applied Research Program, University of Colorado School of Medicine, Aurora, CO, USA.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Meguid
authors.affiliation: Surgical Outcomes and Applied Research Program, University of Colorado School of Medicine, Aurora, CO, USA.
authors.forename: Patrick W
authors.initials: PW
authors.lastname: Hosokawa
authors.affiliation: Surgical Outcomes and Applied Research Program, University of Colorado School of Medicine, Aurora, CO, USA; Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, CO, USA; Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO, USA.
authors.forename: William G
authors.initials: WG
authors.lastname: Henderson
authors.affiliation: Surgical Outcomes and Applied Research Program, University of Colorado School of Medicine, Aurora, CO, USA; Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, CO, USA; Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA.
authors.forename: Karl E
authors.initials: KE
authors.lastname: Hammermeister
authors.affiliation: Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA; Surgical Outcomes and Applied Research Program, University of Colorado School of Medicine, Aurora, CO, USA.
authors.forename: Richard D
authors.initials: RD
authors.lastname: Schulick
authors.affiliation: Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA.
authors.forename: Ryan C
authors.initials: RC
authors.lastname: Shelstad
authors.affiliation: Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA.
authors.forename: Trevor T
authors.initials: TT
authors.lastname: Wild
authors.affiliation: Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA.
authors.forename: Robert C
authors.initials: RC
authors.lastname: McIntyre
mesh_terms: D054869:Clinical Audit; D003120:Colorado / Q000453:epidemiology; D016208:Databases, Factual; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D017053:Infection Control / Q000379:methods / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D010360:Patient Transfer / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000601:surgery*; D058996:Quality Improvement; D012086:Reoperation / Q000706:statistics & numerical data*; D012189:Retrospective Studies
keywords: ACS; NSQIP; Quality improvement; Reoperation; Unplanned return to the operating room