Using an Electronic Perioperative Documentation Tool to Identify Returns to Operating Room (ROR) in a Tertiary Care Academic Medical Center.
The metric "Unplanned returns to operating room (ROR)" is being tracked in surgical quality dashboards; 70% of unplanned RORs may be related to surgical complications. With increasing regionalization of trauma and complex surgical care at tertiary care academic centers, it is unclear if a simple ROR metric is a valid assessment of surgical quality at such centers.



A real-time electronic tool was used to identify all RORs-planned and unplanned-in a high-volume, high-complexity academic surgical practice at Mayo Clinic-Rochester within 45 days of the index operation. Analysis by ROR type and indication was performed.



During the analysis period (June 2014-February 2015) 44,031 operations were performed, with 5,552 subsequent RORs (13%). Of all RORs, 51% (n = 2,818) were planned staged returns, 29% (n = 1,589) were unrelated, 15% (n = 830) were unplanned and 6% (n = 315) were planned because of previous complications. Overall, unplanned reoperations were uncommon (n = 830, 2% of all operations). The most common indications for unplanned RORs included "other" (32%, n = 266), bleeding related (24%, n = 198) and wound complications (20%, n = 166).



In a high-volume, high-complexity academic surgical practice, RORs occurred after 13% of cases. Unplanned returns were infrequent and usually were associated with complications; most RORs were planned staged or unrelated returns. A simple ROR metric that does not consider planned/unrelated returns is likely not a valid surgical quality measure. Electronic tools designed specifically to identify in real-time RORs, associated indication, and clinical validation should provide more reliable data for public reporting and quality improvement efforts.
Robert R
RR
Cima
Sarah R
SR
Dhanorker
Christopher L
CL
Ostendorf
Mfonabasi
M
Ntekpe
Raghu V
RV
Mudundi
Elizabeth B
EB
Habermann
Claude
C
Deschamps
D000046:Academic Medical Centers; D004282:Documentation; D006801:Humans; D007256:Information Systems / Q000458:organization & administration*; D009873:Operating Rooms / Q000458:organization & administration; D059035:Perioperative Period; D011183:Postoperative Complications / Q000453:epidemiology; D058996:Quality Improvement / Q000706:statistics & numerical data*; D012086:Reoperation / Q000706:statistics & numerical data*; D012307:Risk Factors; D063128:Tertiary Health Care / Q000706:statistics & numerical data*