Early reoperation – a quality parameter for monitoring laparoscopic surgery ?

Background:The science of surgical quality measurement is evolving!
The need for unplanned early reoperation usually represents a major adverse event in the patient’s postoperative course. Unplanned early reoperations were suggested as a possible quality indicator in general surgery .There are only a small number of prospective studies concerning this issue in general surgery, and no reports about What are the acceptable, reoperation rates, post laparoscopic surgery. The aim of this review was to assess the incidence and outcome of reoperation for laparoscopic surgery as a practical quality indicator
Methods: retrospective review of medical records.
Study population: All patients operated between 1/1/98 – 17/8/2003
Inclusion criteria: Early reoperation was defined as a second surgical procedure within thirty days, required due to a complication resulting from the index operation
Results: The number of Patients meeting inclusion criteria was 335 /16071 (2.1%) of which 241/7360 (3.36%) underwent laparotomy, 47/4093 (1.12%) laparoscopy and 47/4618 (1%) other incisions. The rates of the common “classical” indications for re-exploration were all higher post laparotomy comparing to post laparoscopy (sepsis 1.37% vr 0.66%, bleeding 0.66% vr 0.2%, bowel obstruction 0.43% vr 0.07% and wound failure 0.44% vr 0.05%) .
In 15/47 (31.9%) of the post laparoscopy patients, the need for re-exploration may be related directly to a complication of the laparoscopic technique. The most common indications for reoperation in this group was missed enterotomy (8/15 53%), bile leak (3/15 20%), trocar site hernia (2/15 13%), Misinterpretation of anatomy & vascular compromise of unrelated organ (2/15 13%).
In 52/288 (18%) of the post non laparoscopic group the re-exploration was Negative/Non therapeutic versus 10/47 (21%) of the laparoscopic group.
Mortality rate was 40/335 (11.9%) of reoperated patients and 3/47(6.4%) of the post laparoscopic group. The highest mortality was seen with in the patients that were reoperated due to sepsis – 19%.
Conclusions: the unplanned re-exploration rate is lower post laparoscopic surgery than post laparotomy and it’s about 1%. This difference may be due to the severity of underlying diseases or the complexity of the procedures. The use of laparoscopic technique has a potential for unique “laparoscopy related” complications.
Most common factors affecting morbidity & mortality are the reason of reoperation.
Reoperation rates constitute a convenient parameter for monitoring quality in surgical services

Session: Podium Presentation

Program Number: S103

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