Unplanned Returns to Theatres in Emergency General Surgery; What can be improved?

Abstract

Abstract Introduction Unplanned return to theatre impacts physical, psychological, social and financial aspects of patients and healthcare. It is a significant adverse event, which can be avoided, nonetheless reduced. This study aims to review the incidence of unplanned return to theatre in Emergency General Surgery at a District General Hospital. Methods A retrospective review of patients undergoing Emergency General Surgery between January 2019 to January 2021 was done. Data was obtained from the hospital management information systems. The operations were classified based on primary operation, followed by indication for the return. Results A total number of 1578 patients underwent emergency general surgery operations over a period of 25 months (Jan 2019-Jan 2021). The unplanned return to theatres (URTT) were 85 (5.3%), with a 90-day mortality of 16. There were 12 (14.11%) appendicectomies, 7 (8.2%) necrotizing fasciitis, 25 (29.4%) abscess, 5 (5.8%) hernias, 16 (18.8%) large bowel, 19 (22.3%) small bowel operations and 1 (1.17%) laparoscopic cholecystectomy. The total number of appendicectomies were 302 with 3.9% (12) URTT. Similarly, 4.2% (n=583) abscesses, 22.8% (n=70) large bowel operations, 6% (n=316) small bowel operations were returned. 66% of the abscesses were returned for redo/debridement. Conclusion Unplanned returns to theatres pose a major burden to the healthcare system. There is no established data for an acceptable rate of URTT in emergency general surgery. Most of the returns in our study, are due to haemorrhage or inadequate drainage of the abscess, both of these complications could easily be prevented with meticulous surgical technique.