Unplanned reoperations for infection complications: a survey for quality control

Abstract

Background: Unplanned reoperation is perceived as a quality indicator for surgical procedures. However, there is a lack of data regarding the extent to which infections add to the reoperation rate. We studied the role of infection as an indication for unplanned reoperation.

Methods: The setting was a surgical department at an academic teaching hospital performing a spectrum of general, vascular, thoracic (lung), and transplant (kidney) procedures. Between January, 2003 and September, 2004, data on operations, unplanned reoperations, and complications were documented prospectively. Unplanned reoperation was defined as unexpected reoperation within 30 days of the primary procedure. Endpoints were the number of unplanned reoperations attributable to infection, the site of the infection, the type of the primary operation, and deaths.

Results: A total of 6,287 operations were performed during the study period. The rate of unplanned reoperations was 1.34% (84/6287), and 15 (17.9%) of these 84 patients had to undergo reoperation because of an infection. The primary operations in these cases were general surgical procedures in 11 patients, kidney transplant in two patients, and vascular surgery and lung resection in one patient each. Leakage of a gastrointestinal anastomosis was the predominant cause in the general surgical group (8/11). The most frequent initial procedure was colon resection (n = 4) followed by ileostomy closure (n = 2) and kidney transplant (n = 2). One unplanned reoperation had to be done after esophagectomy, pancreatoduodenectomy, pneumonectomy, incisional hernia repair, appendectomy, femoro-femoral bypass, and resection of a soft tissue tumor. The mortality rate after unplanned reoperation for infection was 20% (3/15), a significantly higher rate than in patients not having reoperation (p < 0.00001). Subgroup analysis did not show any significant difference in mortality according to whether the unplanned reoperation was indicated by infection, bleeding, or other reason (p = 0.28). Patients who required operation because of an infection stayed significantly longer in the intensive care unit (p = 0.018) and underwent more reoperations (p = 0.003) than those with other indications for reoperation.

Conclusion: Infections add considerably to the rate of unplanned reoperation. The mortality rate is high, but not significantly different from that in patients having reoperation for other indications. A longer stay in the intensive care unit and a higher number of reoperations indicate a greater use of resources by these patients.