A transplant surgeon I trained under in Chicago once told me that one of the worst errors a surgeon can make is failure to return a patient to the OR in a timely fashion. In transplant surgery, you're dealing with coagulopathic, extremely ill patients who undergo commando abdominal operations; post operative bleeding can be a commonplace occurence. It was no big deal for those guys to bring a post op liver transplant back to the OR to evacuate a hematoma, even multiple times.
For most general surgeons, however, a return to OR is a major complication. It gets you on the Morbidity and Mortality list. The QA committee sends you a letter. It's a sign of error. You did something wrong. You closed the skin leaving something undone.
It's human nature to deny any intentional wrongdoing. You run the case through your mind. Everything seemed fine. It was dry when you closed. The anastomosis looked beautiful. You checked the ureter. The clips seemed in good position on the cystic duct. So why is the patient not doing well? Could it possibly be related to something I did?
Well, yeah. It's always a possibility. And if the patient is leaking or bleeding or whatever, it isn't going to get better all by itself. In fact, the longer you wait, the worse the final outcome will be. It's amazing how a normally astute general surgeon suddenly transforms into a psychiatry resident in the post-operative period when things start to deteriorate. Peritonitis on exam? Oh, that's probably just pain from the incision. The patient's hemoglobin drifts from 12 to 7 in 24 hours? Hell, it's dilutional! Surely he's not bleeding anymore!
I'd sit next to the aforementioned transplant surgeon at M&M meetings in Chicago and he'd just shake his head. What the hell were they waiting for? A return to the OR may not be the crowning achievement of a surgeon's career, but it may very well be the act that saves a patient's life.