Return to theater following gynecologic surgeries: An institutional audit and review of the literature

Abstract

Objective: Return to theater (RTT) for reoperation following a primary surgery has significant implications for patients and the healthcare system. RTT following gynecologic surgeries is a critical clinical incident trigger for reporting and investigation of root cause analyses. Many of the causes of unexpected return to theater after surgery are avoidable and therefore provide essential learning opportunities to prevent future recurrence and to improve patient experience especially in those at risk of specific complications. Methods: The present study was a mixed method retrospective review of all unexpected reoperations following gynecologic surgeries over a 7-year period at Mid Yorkshire Teaching Hospitals NHS Trust and a review of the literature. Results: There were 24 RTTs following gynecologic surgeries during the period. The overall RTT rate was three per 1000. Hysterectomies accounted for 14 (58.3%) of the reoperations. Similarly, 11 (45.8%) of the reoperations were as a result of hemorrhagic complications. Other themes identified include port site hernia in three patients (12.5%), ureteric injury in two patients (8.3%), while three patients (12.5%) had no abnormality detected at reoperation. Conclusion: Unexpected reoperation following gynecologic surgery is an uncommon complication at three per 1000 surgeries. Reactionary and secondary hemorrhages are the most common causes and hysterectomy irrespective of the approach remains the leading primary surgery. The causes are largely preventable.