| Abstract | Cilj: Utvrditi neplanirane ponovne operacije unutar 30 dana u Klinici za dječju kirurgiju te evaluirati neplanirane reoperacije kao pokazatelj kvalitete rada u kirurgiji. Metode i materijali: Retrospektivno istraživanje provedeno je u trogodišnjem periodu u Klinici za dječju kirurgiju KBC-a Split. Iz pisanih protokola i arhiva povijesti bolesti prikupljeni su podaci o svoj djeci operiranoj od 1. siječnja 2018. do 31. prosinca 2020. godine. Svakom ispitaniku analizirani su sljedeći parametri: dob, spol, indeks tjelesne mase, komorbiditeti, uzroci primarne i neplanirane ponovne operacije, vrsta prve operacije (žurno/elektivno), duljina hospitalizacije prve i neplanirane ponovne operacije, duljina vremena proteklog od primarne operacije do neplanirane ponovne operacije, vrijeme primarne operacije, trajanje operacije, trajanje anestezije, ASA klasifikacija, čistoća rane kod primarne operacije, NNIS indeks.
Rezultati: U trogodišnjem razdoblju studije operirano je 3982 djece (2018., n=1432; 2019., n=1435; 2020., n=1115). Od toga je 3032 djece operirano elektivno, a ostalih 950 žurno. Unutar 30 dana neplanirano je ponovno operirano 19-ero djece, odnosno 0,48% od ukupnog broja djece (2018., n=6; 2019., n=6; 2020., n=7). U reoperiranoj skupini bilo je 14 dječaka (73,69%) i 5
djevojčica (26,31%) (P=0,002), a medijan životne dobi sve djece iznosio je 11 godina (IQR 3, 16). Udio broja neplaniranih ponovnih operacija tijekom trogodišnjeg istraživanja je za 4,5 puta veći kod žurnih nego kod elektivnih operacijskih zahvata (P<0,001). U skupini elektivno operirane djece 50% ih je imalo ASA≥3 (P=0,016). Najčešća operacija kod neplanirano ponovno operirane djece bila je apendektomija (n=5, 26,3%), najčešće indikacije za reoperaciju bile su komplikacije rane (n=7, 36,9%), a najčešći uzrok reoperacija pogreške u kirurškoj tehnici (n=11, 57,9%).
Zaključci: Neplanirane ponovne operacije unutar 30 dana mogu biti dobar pokazatelj kvalitete rada u kirurgiji. Stopa neplaniranih reoperacija u našoj studiji bila je 0,48%. Čimbenici rizika za neplanirane reoperacije su žurne primarne operacije i ASA indeks veći ili jednak tri u skupini elektivno operirane djece. |
| Abstract (english) | Aim: The aim of this study was to establish the rate of unplanned return to the operating room (uROR) within 30 days in our clinic and to evaluate if uROR can be used as a quality indicator in surgery.
Methods and materials: A retrospective study was done in a three year period in the Clinic for Pediatric Surgery at the University Hospital of Split. Patient data was collected from registers and archives from January 1st 2018 to December 31st 2020. We recorded the following variables for each patient: age, gender, body mass index, comorbidities, causes for operation and reoperation, type of first surgery (emergency/elective), length of both hospitalizations, amount of days between the two surgeries, starting time, duration of operation, anesthesia, ASA classification, wound status and NNIS index.
Results: A total of 3982 operations were preformed in the three year period (2018., n=1432; 2019., n=1435; 2020., n=1115). Elective surgery was preformed in 3032 patients, while 950 children underwent emergency surgery. Within the 30 days period, 19 patients underwent an unplanned reoperation (2018., n=6; 2019., n=6; 2020., n=7). The overall unplanned reoperation rate was 0.48%. In the study group there were 14 boys (73.96%) and 5 girls (26.31%) (P=0.002). The median of age was eleven years (IQR 3, 16). The share of uROR was 4.5 times bigger within the emergency reoperated group (P<0.001). Out of children that were operated in elective surgery, 50% had ASA score three or higher (P=0.016). The most common surgery preformed in the uROR group was appendectomy (n=5, 26.3%). Most often the indications for unplanned reoperation were wound complications (n=, 36.9%), while the errors in surgical technique were the most common cause for uROR (n=11, 57.9%).
Conclusions: Unplanned reoperations within 30 days of the initial procedure can be a good quality indicator in surgery. Rate of uROR in our study was 0.48%. Risk factors associated with unplanned reoperations are emergency initial operations and ASA score three or higher in elective pediatric surgery. |
