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.
