Unplanned Return to the Operating Room after Elective Oncologic Thoracic Surgery: A Further Quality Indicator in Surgical Oncology

SIMPLE SUMMARY: An unplanned return to the operating room (UROR) is defined as a readmission to the operating room because of a complication or an untoward outcome related to the initial surgery. It has been widely used as an indicator of surgical care quality among hospitals. The aim of this paper is to evaluate the role of URORs after elective oncologic thoracic surgery in a high-volume, oncologic referral center, focusing on risk factors and variables that influence the UROR rate. Our findings disclosed that UROR is an effective and reliable quality indicator in oncologic thoracic surgical care; patients experiencing UROR after elective oncologic thoracic surgery have a higher morbidity and mortality rate when compared to standard thoracic surgery. Patients presenting complications after UROR had been submitted to a significantly longer first procedure, had a significantly longer length of stay and a higher post-operative mortality. Bronchopleural fistula remains the most lethal complication in patients undergoing UROR. ABSTRACT: Background: An unplanned return to the operating room (UROR) is defined as a readmission to the operating room because of a complication or an untoward outcome related to the initial surgery. The aim of the present report is to evaluate the role of URORs after elective oncologic thoracic surgery. Methods: In the study, 4012 consecutive patients were enrolled; among them, 71 patients (1.76%) had an unplanned return to the operating room. Age, sex, Charlson comorbidity index, induction treatments, type of the first operation, indication to readmission to the operating room and type of second operation, length of stay, complication after reoperation and outcomes were collected. Results: The mean age was 63.3 (SD: 13.0); there were 53 male patients (74.6%); the type of the first procedure was: lower lobectomy (11.3%), middle lobectomy (1.4%), upper lobectomy (22.5%), metastasectomy (5.6%), extrapleural pneumonectomy (4.2%), pneumonectomy (40.9%), pleural biopsy (5.6%) and other procedures (8.5%). Patients presenting complications after UROR had undergone a significantly longer first procedure (p < 0.02), had a longer length of stay (p < 0.001) and had higher post-operative mortality (p < 0.001). Conclusions: The patients experiencing UROR after elective oncologic thoracic surgery have significantly higher morbidity and mortality rates when compared to standard thoracic surgery. Bronchopleural fistula remains the most lethal complication in patients undergoing UROR.