骨科30日内非计划再手术的影响因素分析:基于单中心54620例患者的大宗病例研究  

Influencing factors for unplanned reoperations within 30 days after orthopaedic surgery:a single-center study based on 54620 cases

作　　者：欧阳汉强 胡元裕 胡文爽 张华[5] 董彦雷 孙卓然[1,2,3] 姜宇 曾琳[5] 陈剑铭 李维[7] 董书[4] 孙垂国[1,2,3] 田华[1,2,3] 田耘[1,2,3] 李危石 OUYANG Hanqiang;HU Yuanyu;HU Wenshuang;ZHANG Hua;DONG Yanlei;SUN Zhuoran;JIANG Yu;ZENG Lin;CHEN Jianming;LI Wei;DONG Shu;SUN Chuiguo;TIAN Hua;TIAN Yun;LI Weishi(Department of Orthopaedics,Peking University Third Hospital,Beijing 100191;Engineering Research Center of Bone and Joint Precision Medicine,Beijing 100191;Beijing Key Laboratory of Spinal Disease Research,Beijing 100191;Department of Medical Affairs,Peking University Third Hospital,Beijing 100191;Epidemiology Center,Peking University Third Hospital,Beijing 100191;Department of Medical Record,Peking University Third Hospital,Beijing 100191;Department of Information Management and Big Data Center,Peking University Third Hospital,Beijing 100191,China)

机构地区：[1]北京大学第三医院骨科,北京100191 [2]骨与关节精准医学工程研究中心,北京100191 [3]脊柱疾病研究北京市重点实验室,北京100191 [4]北京大学第三医院医务处,北京100191 [5]北京大学第三医院临床流行病学研究中心,北京100191 [6]北京大学第三医院病案科,北京100191 [7]北京大学第三医院信息管理与大数据中心,北京100191

出　　处：《中华骨与关节外科杂志》2023年第2期113-121,共9页Chinese Journal of Bone and Joint Surgery

基　　金：北京大学第三医院队列建设项目(BYSYDL2022007);北京大学第三医院临床重点项目(BYSYZD2021040);国家自然科学基金(82102638);北京大学医学部教育教学研究立项课题(2021YB05)。

摘　　要：目的:探讨骨科手术患者30日内非计划再手术的影响因素。方法:回顾性分析2016年1月至2021年7月收治的骨科手术患者54620例,对患者的年龄、性别、疾病类型、手术并发症、再手术原因与再手术时间的关系进行分析,探讨骨科手术患者30日内非计划再手术的影响因素。结果:收治的54620例骨科手术患者中329例进行了30日内非计划再手术,再手术率为0.60%。男188例(57.1%),女141例(42.9%);年龄18~83岁,平均(55.6±12.9)岁。再手术病例按疾病类型分为:脊柱退变267例(再手术率0.80%)、关节退变13例(再手术率0.16%)、创伤骨折19例(再手术率0.17%)、脊柱畸形13例(再手术率1.50%)、脊柱肿瘤17例(再手术率1.63%)。再手术病例按发生原因分为:术后血肿形成150例(再手术率0.28%)、切口并发症66例(再手术率0.12%)、神经功能障碍38例(再手术率0.07%)、内置物位置不佳28例(再手术率0.05%)等18种原因。再手术病例按发生时间分为:超急性期(术后0~1 d)140例、急性期(术后2~7 d)107例、亚急性期(术后8~14 d)54例、慢性期(术后15~30 d)28例。单因素分析结果显示21个影响因素的差异有统计学意义,进一步多因素Poisson回归分析显示,贫血(P=0.004,RR=1.870,95%CI:1.217~2.873)、脊髓水肿(P=0.0311,RR=4.626,95%CI:1.150~18.613)、强直性脊柱炎(P=0.018,RR=2.634,95%CI:1.180~5.878)、术前足下垂(P=0.043,RR=2.567,95%CI:1.033~6.381)和既往手术史(P<0.001,RR=2.081,95%CI:1.647~2.629)为骨科30日内非计划再手术的独立危险因素。结论:骨科30日内非计划再手术率为0.60%,最常见原因包括术后血肿、切口并发症、神经功能障碍和内固定位置不佳,最常发生非计划再手术的时间段为术后24 h内,独立危险因素为贫血、脊髓水肿、强直性脊柱炎、术前足下垂和既往手术史。骨科医师应在围手术期进行详细规划、制定合理管理方案,以降低30日内非计划再手术的发生率,有利于骨科手�Objective:To investigate the influencing factors for unplanned reoperations within 30 days after orthopaedic surgery.Methods:A retrospective analysis of 54620 patients who were admitted and underwent surgical treatment in our hospital from January 2016 to July 2021 was conducted.Their ages,genders,disease types,surgical complications and relationship of cause and time of reoperation were analyzed.The influencing factors for unplanned reoperation within 30 days after the orthopaedic surgery were explored.Results:There were 329 unplanned reoperations in 54620 patients with an overall reoperation rate of 0.60%.There were 188(57.1%)males and 141(42.9%)females,with an average age of(55.6±12.9)years(range,18-83 years).All patients undergoing unplanned reoperations were classified into spinal degenerative patients(n=267,reoperation rate 0.80%),joint degenerative patients(n=13,reoperation rate 0.16%),traumatic fracture patients(n=19,reoperation rate 0.17%),patients with spinal deformity(n=13,reoperation rate 1.50%)and patients with spinal tumors(n=17,reoperation rate 1.63%)by disease type;were classified into postoperative hematoma patients(n=150,reoperation rate 0.28%),patients with incision complications(n=66,reoperation rate 0.12%),patients with neurological dysfunction(n=38,reoperation rate 0.07%),patients with poor placement of the implant(n=28,reoperation rate 0.05%),and so on by cause of disease;were classified into the hyperacute period(postoperative 0-1 day,n=140),the acute period(postoperative 2-7 days,n=107),the subacute period(postoperative 8-14 days,n=54),the chronic period(postoperative 15-30 days,n=28)according to time of reoperation.A total of 21 factors were significantly different in clinical univariate analysis.Multivariate Poisson regression analysis showed that anemia(P=0.004,RR=1.870,95%CI:1.217-2.873),spinal cord edema(P=0.031,RR=4.626,95%CI:1.150-18.613),ankylosing spondylitis(P=0.018,RR=2.634,95%CI:1.180-5.878),preoperative foot drop(P=0.043,RR=2.567,95%CI:1.033-6.381),and previous surgical hist

关 键 词：非计划再手术 脊柱 关节 创伤 发生率 临床原因 危险因素 

分 类 号：R68[医药卫生—骨科学] R197[医药卫生—外科学]