Surveillance of unplanned return to the operating theatre in neurosurgery combined with a mortality--morbidity conference: results of a pilot survey

BMJ Quality & Safety
Hélène MariniPierre Czernichow

Abstract

Unplanned return to the operating theatre (UROT) is a useful trigger tool that could be used to identify surgical adverse events (SAEs). The present study describes the feasibility of SAE surveillance in neurosurgical patients, based on UROT identification, completed with SAE analysis at a morbidity-mortality conference (MMC) meeting. For consecutive patients who underwent a neurosurgical procedure between 1 November 2008 and 30 April 2009, return to the operating theatre (ROT) was identified based on the hospital information system associated to prospective payment (HISPP). ROT was classified as planned or unplanned and UROT was further classified as related to the natural history of the disease or related to an adverse event (AE-UROT). MMC meetings were organised to discuss results of UROT surveillance and to analyse AE-UROT. 1006 neurosurgical procedures were included in the surveillance. HISSP identified 152 ROTs, with 73 UROTs related to an SAE (7.3% (5.7% to 9.0%)): infectious SAE (n=24, 2.4% (1.5% to 3.5%)), haemorrhagic SAE (n=23, 2.3% (1.5% to 3.4%)), other cause SAE (n=26, 2.8% (1.9% to 4.0%)), and infectious and other cause SAE (n=2, 0.2% (0.0% to 0.7%)). Identification of AE-UROT through HISSP required a 4 h/month t...Continue Reading

Citations

Nov 19, 2013·Journal of Neurosurgery. Pediatrics·Erik J van LindertJody Leonardo
Oct 12, 2015·Supportive Care in Cancer : Official Journal of the Multinational Association of Supportive Care in Cancer·Véronique MerlePierre Czernichow
Mar 31, 2015·Journal of Neurosurgery·Nancy McLaughlinNeil A Martin
May 9, 2015·Orthopaedics & Traumatology, Surgery & Research : OTSR·N PujolP Beaufils
Apr 1, 2017·Journal of Neurosurgery. Pediatrics·Anil K RoyJoshua J Chern
Jun 25, 2017·World Neurosurgery·Borys M KwintaMarek Moskała
Jul 20, 2018·Australian Health Review : a Publication of the Australian Hospital Association·Corey W JosephAngela M Melder
Sep 10, 2017·Soins. Psychiatrie·Laurent BoyerPatrice François

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