An analysis of unplanned return to the operating room following deceased donor kidney transplantation

This study was undertaken to characterize unplanned return to the OR following kidney transplantation(KT). All patients undergoing KT at a single center from 1/2015 through 11/2017 were evaluated. The primary endpoint was unplanned return to the OR within 90 days. Perioperative and one year patient and graft outcomes were also determined. Of 190 patients, 14(7.4%) of patients had unplanned reoperation. The most common individual indications were bleeding from biopsy sites(n = 2), poor vascular flow on postop ultrasound(n = 4), and perforated diverticulitis(n = 2). Forty Three percent of all reoperations were unrelated to the technical conduct of the transplant operation. Reoperated patients had significantly worse survival at one year(78.6% vs. 96.6%), although graft function in survivors was similar to those who did not return to the OR. Reoperation following KT is frequently unrelated to the technical conduct of the transplant procedure, thus it may not be useful as a quality metric. •Unplanned return to the operating room occurs after 7.1% of kidney transplants.•General surgery emergencies such as diverticulitis and cholecystitis account for 30% of reoperations.•Half of reoperations after kidney transplant are unrelated to the technical conduct of the transplant operation. Unplanned return to the operating room following kidney transplantation is unrelated to the technical conduct of the transplant procedure in 50% of cases. This calls into doubt the utility of unplanned reoperation as a quality metric for renal transplant surgery.