280 IRT30 [Inadvertent Returns to Theatre Within 30 Days]: Highlighting the Value of This Novel Metric as a Measure of Surgical Performance

Abstract

Abstract Introduction Unplanned return to theatre is commonly associated with a problem at the original operation. IRT30 is a potentially valuable but underutilised metric. Use of this metric in Governance Meetings allows for standardisation of the selection of patients, objective assessment of morbidity & mortality, and can facilitate an improvement in surgical performance and ultimately outcome. Method The complications associated with IRT30 can be graded from Type I to V ranging from Avoidable/Understandable/Major/Serious through to ‘Never events’. We reviewed all emergency procedures prospectively from February to April 2021. Planned returns and returns after 30 days from index operation were excluded. Patients’ notes were individually reviewed, and cases were grouped by subspecialty [Colorectal, Upper Gastrointestinal (UGI) and General] and ‘IRT30 graded’ accordingly. Results A total of 486 cases were performed. 20 were unplanned returns to theatre (4.3%). The majority of cases were Colorectal [75% (15/20)] with 20% UGI (4/20)]. There were 3 Type 1, 6 Type 2 and 11 Type 3 IRT30. 4 patients with perianal sepsis required further surgery (Type 2). Bleeding, ischaemia, and anastomotic leak were most commonly associated with IRT30. No ‘serious’ or ‘never’ events were recorded. Conclusions IRT30 is an underutilised useful objective metric that can be employed routinely in Governance meetings to improve surgical performance and outcomes. Perianal sepsis requires experienced involvement at the index operation. Bile leaks are more frequent than perhaps we expect following laparoscopic cholecystectomy, but a proactive approach should be encouraged.