title: Reoperations within 48 hours following 7942 pediatric neurosurgery procedures.
abstract: OBJECTIVE Various indicators are used to evaluate the quality of care delivered by surgical services, one of which is early reoperation rate. The indications and rate of reoperations within a 48-hour time period have not been previously reported for pediatric neurosurgery. METHODS Between May 1, 2009, and December 30, 2014, 7942 surgeries were performed by the pediatric neurosurgery service in the operating rooms at a single institution. Demographic, socioeconomic, and clinical characteristics associated with each of the operations were prospectively collected. The procedures were grouped into 31 categories based on the nature of the procedure and underlying diseases. Reoperations within 48 hours at the conclusion of the index surgery were reviewed to determine whether the reoperation was planned or unplanned. Multivariate logistic regression was employed to analyze risk factors associated with unplanned reoperations. RESULTS Cerebrospinal fluid shunt-and hydrocephalus-related surgeries accounted for 3245 (40.8%) of the 7942 procedures. Spinal procedures, craniotomy for tumor resections, craniotomy for traumatic injury, and craniofacial reconstructions accounted for an additional 8.7%, 6.8%, 4.5%, and 4.5% of surgical volume. There were 221 reoperations within 48 hours of the index surgery, yielding an overall incidence of 2.78%; 159 of the reoperation were unplanned. Of these 159 unplanned reoperations, 121 followed index operations involving shunt manipulations. Using unplanned reoperations as the dependent variable (n = 159), index operations with a starting time after 3 pm and admission through the emergency department (ED) were associated with a two- to threefold increase in the likelihood of reoperations (after-hour surgery, odds ratio [OR] 2.01 [95% CI 1.43-2.83, p < 0.001]; ED admission, OR 1.97 (95% CI 1.32-2.96, p < 0.05]). CONCLUSIONS Approximately 25% of the reoperations within 48 hours of a pediatric neurosurgical procedure were planned. When reoperations were unplanned, contributing factors could be both surgeon related and system related. Further study is required to determine the extent to which these reoperations are preventable. The utility of unplanned reoperation as a quality indicator is dependent on proper definition, analysis, and calculation.
authors.affiliation: Department of Neurosurgery, Emory University School of Medicine; and.
authors.forename: Anil K
authors.initials: AK
authors.lastname: Roy
authors.affiliation: Department of Neurosurgery, Emory University School of Medicine; and.
authors.forename: Jason
authors.initials: J
authors.lastname: Chu
authors.affiliation: Pediatric Neurosurgery Associates, Children's Healthcare of Atlanta.
authors.forename: Caroline
authors.initials: C
authors.lastname: Bozeman
authors.affiliation: Department of Health Policy & Management, Rollins School of Public Health, Emory University, Atlanta, Georgia.
authors.forename: Samir
authors.initials: S
authors.lastname: Sarda
authors.affiliation: Pediatric Neurosurgery Associates, Children's Healthcare of Atlanta.
authors.forename: Michael
authors.initials: M
authors.lastname: Sawvel
authors.affiliation: Pediatric Neurosurgery Associates, Children's Healthcare of Atlanta.|Department of Neurosurgery, Emory University School of Medicine; and.
authors.forename: Joshua J
authors.initials: JJ
authors.lastname: Chern
mesh_terms: D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D006801:Humans; D015994:Incidence; D007223:Infant; D016015:Logistic Models; D015999:Multivariate Analysis; D019635:Neurosurgical Procedures / Q000706:statistics & numerical data*; D011446:Prospective Studies; D011785:Quality Assurance, Health Care; D012086:Reoperation / Q000706:statistics & numerical data*; D012307:Risk Factors; D012959:Socioeconomic Factors; D013997:Time Factors
keywords: ACGME = Accreditation Council for Graduate Medical Education; ED = emergency department; EVD = external ventricular drain; ICP = intracranial pressure; ICU = intensive care unit; LP = lumboperitoneal; NICU = neonatal ICU; SP/CP = subdural-peritoneal/cyst peritoneal; VA = ventriculoatrial; VAD = ventricular access device; VP = ventriculoperitoneal; pediatric neurosurgery; quality assurance; reoperation