基于三级公立医院绩效考核的手术并发症管理策略研究  

An Analysis of Management Strategy of Surgical Complications Based on Performance Appraisal of Tertiary Public Hospitals

作　　者：胡春兰[1] 张颖[1] 毛莉颖[1] 招慧 陈琳[1] 牟勇[1] HU Chunlan;ZHANG Ying;MAO Liying;ZHAO Hui;CHEN Lin;MOU Yong(Medical Department,Guangdong Second Provincial General Hospital,Guangzhou Guangdong,510317)

机构地区：[1]广东省第二人民医院医务部,广东广州510317

出　　处：《江苏卫生事业管理》2023年第1期63-67,78,共6页Jiangsu Health System Management

基　　金：广东省医学科学技术研究基金项目(A2018479)。

摘　　要：目的:识别和分类手术并发症,并评估各类影响因素,为医院手术质量管理提供依据。方法:根据国家三级公立医院绩效考核指标释义,利用院内绩效考核指标系统收集某三级综合医院2018-2020年手术并发症患者信息,采用Clavien-Dindo分级系统对手术并发症进行分类,应用SPSS软件进行数据统计分析,筛选出与手术并发症患者术后死亡有关的危险因素。结果:在40283例择期手术中,手术并发症发生率为0.52%(209/40283),手术并发症患者死亡率为10.53%(22/209)。手术并发症Clavien-Dindo分级以Ⅱ级较多见,肺部感染、手术后切口愈合不良、深静脉血栓、败血症4种为主要手术并发症;手术类型为血管内修补术、手术病人合并低蛋白血症或电解质紊乱、手术后需要ICU治疗的患者死亡率更高(P<0.05)。结论:择期手术病人,应重点注意术后感染类并发症的发生;手术类型为血管内修补术、手术病人合并低蛋白血症或电解质紊乱等因素对择期手术并发症患者术后死亡有影响,而手术后需要ICU治疗与择期手术并发症患者术后死亡密切相关,这类手术患者应引起临床重视,给予相应干预措施,降低死亡风险。手术患者并发症的管理是围手术期全过程的管理,需要信息化的支撑、多部门的协作,需要手术质量和管理水平双提升作为保障。Objective:The purpose of this study is to identify and classify surgical complications and evaluate the various contributing factors to provide a basis for hospital operation quality management.Methods:According to the interpretation of the performance appraisal indicators of the national tertiary public hospitals,the information of patients was collected from elective surgical complications from 2018 to 2020 in a tertiary general hospital by using the in-hospital performance appraisal index system.The surgical complications were categorized by Clavien-Dindo system,and statistical analysis was performed using SPSS software to screen out the risk factors associated with death in patients with elective surgical complications.Results:The complication rate was 0.52%(209/40283)and mortality rate of complication patients was10.53%in total 40,283 elective surgical procedures.Clavien-Dindo GradeⅡwas the most common surgical complication.Pulmonary infection,poor wound healing,thrombosis and septicemia were the main complications.The mortality rate was higher in patients with endovascular repair operation,hypoalbuminemia or electrolyte disorder,and need for ICU treatment after operation(P<0.05).Conclusion:Patients undergoing elective surgery should pay attention to the occurrence of postoperative infectious complications.Endovascular repair operation,combined with hypoproteinemia or electrolyte disorders were associated with death in patients with surgical complications.Need for ICU treatment after surgical procdure is closely related to the death of elective surgical complications patients,and such patients should pay more attention and given corresponding interventions to reduce the risk of death.The management of complications of surgical patients is the whole process of perioperative management,which needs the support of information technology,the cooperation of multiple departments,and the double improvement of surgical quality and management level as the guarantee.

关 键 词：手术并发症 Clavien-Dindo分级 绩效考核 死亡率 危险因素 

分 类 号：R197.39[医药卫生—卫生事业管理]