The Unplanned Return to the Operating Room in Acute Setting

The return to the operating room in the perioperative settings, or in the acute settings, has not been defined well, despite the fact that it happens often, although the exact frequency of how often we take the patient back is not known. The reason why we need to bring the patient back to the operating room can be divided into planned and unplanned procedures. The unplanned procedures can be classified further into acute (mostly due to bleeding, such as tamponade following CABG or any other major surgery), major infection or some other sort of wound catastrophe (dehiscence), intestinal obstruction, or anastomotic leak that may become evident perioperatively. The planned return to the operating room has been described a bit better (second-look laparotomy, e.g., damage control as described in the chapter on DCL) and planned laparotomy for the management of major intraperitoneal infection. In this chapter I will attempt to address one of the most difficult decision-making in surgery: the unplanned take back of the patient to the operating room the first few weeks postoperatively.