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  • Unplanned Returns to the Operating Room Within 30 Days in Neurosurgery: Insights from a National Surgical Registry

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    Panagiotis Kerezoudis; Mohammed Ali Alvi MD; Robert J. Spinner MD; Fredric B. Meyer MD; Anshit Goyal MBBS; Yagiz Ugur Yolcu; Elizabeth B Habermann PhD; Mohamad Bydon MD

    Study Design:

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    Meeting: Congress of Neurological Surgeons 2018 Annual Meeting

    Introduction: Large-scale data on the appropriateness and utility of unplanned return to the operating room (ROR) as a quality measure in neurosurgery are scarce.

    Methods: We queried the ACS-NSQIP registry for patients undergoing neurosurgical procedures during 2012-2016. The incidence, timing and nature of 30-day unplanned ROR after major procedure groups were determined. Logistic regression was conducted to identify factors associated with 30-day unplanned ROR following the three most common cranial and spinal operations: craniotomy for intra-axial neoplasm, supratentorial meningioma or skull base tumors, anterior cervical discectomy and fusion, posterior lumbar decompression and posterior lumbar fusion.

    Results: A total of 193,459 neurosurgical cases were identified, of which 7067 (3.7%) had at least one unplanned ROR within 30 days after the index procedure. Rates were 4.3% and 1.5% for inpatient and outpatient procedures, respectively. Median time [interquartile range] to ROR was 11 days [4-12]. Overall, the most common reasons were wound complication/surgical site infection (0.7%), hematoma evacuation (0.6%) and repeat surgery (0.5%). Within inpatient cranial cases, the three procedures with the highest 30-day unplanned ROR rates were craniotomies for intracranial infection/abscess (14.7%) followed by subdural hematoma (14.1%), and subarachnoid hemorrhage (12.2%). Within inpatient spinal cases, the highest reoperation rates were observed among thoracic fusions (6.9%), thoracic decompressions (5.6%) and “long” deformity fusions (5%). On multivariable analysis, the relative amount of variation in reoperation risk was found to be 1-25% for demographics, 1-22% for comorbidities, 1-6% for preoperative lab values and 2-46% for operative characteristics.

    Conclusions: Significant variations in rates of 30-day unplanned ROR exist among neurosurgical procedures. The findings may inform stakeholders on the optimal parameters that need to be taken into account when crafting, endorsing and implementing quality metrics for neurosurgery that aim to assess surgical performance and reward or penalize hospitals and providers.

    Patient Care: The National Quality Forum has openly noted the lack of specific measures in neurosurgery, which is considered a high-priority surgical specialty in its portfolio of surgical measures. Similarly, leaders spearheading efforts for quality and safety and value-based care in neurosurgery have called for more evidence in neurosurgery. By discerning the impact of each variable and categories of variables on unplanned reoperations, the findings of the present study may inform stakeholders on the optimal factors that need to be taken into account for quality improvement initiatives and risk-adjustment purposes when crafting surgical quality metrics that aim to assess surgical performance as well as reward/penalize hospitals and providers. Consequently, these actions will hopefully lead in improved patient outcomes.

    Learning Objectives: By the conclusion of this session, participants should be able to: 1. Discuss the role of return to the operating room as a quality metric in neurosurgery. 2. Compare the rates of return of the operating room among commonly performed neurosurgical procedures. 3. Discuss the most common reasons for return to the operating room among neurosurgical cases.


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