Early vs. Late Unplanned Returns to the Operating Room (URTOR) in Neurosurgery: Effect of Surgeon Experience and Complication Types

<i>Background and Objectives</i>: Unplanned return to the operating room (URTOR) is a sensitive indicator of surgical quality; however, data in neurosurgery are limited. This retrospective study analyzed patients who underwent URTOR following neurosurgical procedures over an eight-year period to define early and late patterns, identify underlying causes, and evaluate the distribution of cases according to surgeon experience. <i>Materials and Methods</i>: Records of 18,258 consecutive surgeries including both elective and emergency procedures in adult and pediatric patients, performed at a single center between 2010 and 2018 were retrospectively reviewed. Unplanned reoperations within 30 days of the index surgery were defined as URTOR; those occurring within ≤7 days were classified as "early," and those occurring between 8 and 30 days were classified as "late." Demographic data, surgical characteristics, causes of URTOR, and surgeons' seniority were examined. <i>Results</i>: Among 18,258 neurosurgical procedures, 324 URTORs (1.8%) were identified. The median patient age was 38 years; 37% were children. Early URTOR comprised 59% and was primarily associated with hemorrhagic-vascular complications, whereas late URTOR accounted for 41% and was dominated by cerebrospinal fluid-related and infectious complications. Late events prevailed in significantly younger cases and were disproportionately followed by ventriculo-peritoneal shunt or endoscopic third ventriculostomy index operations. Junior surgeons performed 74% of later operations requiring URTOR versus 30% of early failures. Sex, weekday/weekend timing, and surgeons' experience did not affect the overall URTOR classification categories. The median interval was six days. <i>Conclusions</i>: Centers worldwide have begun to examine URTOR rates, which are directly associated with hospital quality measurements. These results may inform targeted education and prevention by identifying patient groups at higher reoperation risk within a specific timeframe.