Unplanned return to the operating room in the neurosurgical population: What drives this dreaded event?

Document Type

Conference Proceeding

Publication Date


Publication Title

J Am Coll Surg


INTRODUCTION: The unplanned return to the operating room (OR) is a difficult problem for neurosurgeons. It is particularly sensitive with our patients and of scrutiny in quality collaboratives, regulatory reporting, and associated with technical issues and concerns. There is a paucity of data to guide monitoring of surgical performance and to facilitate accurate expectation management of our patients. We sought to better understand the drivers of this dreaded event. METHODS: Under the data operating agreement of the American College of Surgeons, the participant use file of the NSQIP databse was queried for neurosurgical cases that were part of the 4 major categories of neurosurgical procedures: spine, vascular, tumor, and functions. Data from 2005 to 2014 were utilized. Univariate and multivariate analyses were done. RESULTS: A total of 2, 285 patients were analyzed, 943 of whom returned to the operating room. Age, sex, history of MI, smoking history, history of transient ischemic attack, previous percutaneous coronary intervention, and history of renal failure were not statistically significant predictors of return to OR. The following variables were significant by univariate analysis at p < 0.001: diabetes, work relative value units, congestive heart failure (CHF), COPD, steroid use, preop-erative impaired sensorium, cerebrovascular accident (CVA), central nervous system tumor, bleeding disorder, operative time, and American Society of Anesthesiologists (ASA) class. By multivariate analysis, the largest odds ratios were associated with CHF, COPD, underweight BMI, dirty wound class, frailty, and functional cases. CONCLUSIONS: Although retrospective, this represents a beginning of establishing a risk model of return to OR in our neurosurgical population.




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