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Invited Critique |

Is Unplanned Return to the Operating Room a Useful Quality Indicator in General Surgery?—Invited Critique

Gerald W. Peskin, MD
Arch Surg. 2001;136(4):411. doi:10.1001/archsurg.136.4.411.
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The VA Outcomes Group and the Quality Scholars Program at Dartmouth led by John Birkmeyer, MD, have undertaken a review of unplanned returns to the operating room following a series of general surgery cases. The purpose of their presentation is the utilization of these data as a means of assessing the quality of a general surgery service.

While the hypothesis is a commendable one, there are many reasons why patients may require reoperation following initial procedures. Although technical error is certainly one of these reasons, many patient- and hospital-related factors are difficult to quantify in terms of their contribution to untoward patient outcomes (ie, type of hospital, presence of house staff and medical students, criteria for reoperation as opposed to nonoperative approaches [interventional radiology], nature of patients [steroid dependent, receiving anticoagulants, etc], thoroughness of reporting [morbidity and mortality conferences, etc], volume of case experience). If we do not adjust for these factors, we will be comparing apples with oranges in establishing standards. Looking over the sparse literature in this area, one can find reoperation rates of 0.6% to almost 10%,1,2 depending on the operations reviewed and the restrictions imposed. Thus, it seems appropriate that whatever information is obtained by individual hospital study be applied only locally to attempt improvement in patient care. Obviously, only with a free flow of information can improvement be achieved. This series, with a small number of reoperations, is a start.

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