北京某医院非计划再手术病例分析  

Analysis on Unplanned Reoperation Cases in a Hospital in Beijing

作　　者：张娟 张怡 侯佳 鱼锋 Zhang Juan;Zhang Yi;Hou Jia;Yu Feng(Beijing Jishuitan Hospital,Capital Medical University,Beijing 100035,China;不详)

机构地区：[1]首都医科大学附属北京积水潭医院,北京市100035

出　　处：《中国病案》2024年第10期17-20,共4页Chinese Medical Record

基　　金：院级管理创新项目(GL202402)。

摘　　要：目的通过分析非计划再手术病例的主要科室分布、再手术原因及影响因素,进一步完善手术质量安全管理体系,提升医疗机构手术安全管理能力。方法选取2023年1月1日-2023年12月31日出院手术病例56966例,非计划再手术病例38例(再手术组),其他手术病例56928例(非再手术组)。分别统计再手术组科室构成及再手术原因,同时对两组病例的性别、年龄、入院方式、手术级别、手术时长、合并症与再手术的关系进行分析,探讨非计划再手术的影响因素,数据处理采用SPSS26.0统计软件。结果非计划再手术病例构成排名前三的科室为脊柱外科(36.84%)、普通外科(18.42%)、创伤骨科(10.53%)和矫形骨科(10.53%);再手术主要原因为术后血肿(42.11%)、切口并发症(21.05%)、内固定位置不佳(7.89%)和神经损伤(7.89%);单因素分析结果显示:三、四级手术再手术率明显高于一、二级手术(χ^(2)=14.716)、手术时长≥3小时手术再手术率明显高于手术时长<3小时手术(χ^(2)=46.812)、合并冠心病的病例再手术率高于不合并者(χ^(2)=46.815)、合并贫血的病例再手术率高于不合并者(χ2=63.451),以上结果均P<0.001,差异具有统计学意义。结论高级别手术和部分合并症增加非计划再手术率,术后血肿是再手术的最主要原因。加强围手术期管理,严格落实手术分级管理制度是保证手术质量安全的重要举措。Objectives By analyzing the main department distribution,reasons for reoperation,and influencing factors of unplanned reoperation cases,aiming to further improve the surgical quality and safety management system and enhance the surgical safety management capabilities of medical institutions.Methods To select 56966 discharged surgical cases from January 1st,2023 to December 31st,2023,38 unplanned reoperation cases(reoperation group),and 56928 other surgical cases(non-reoperation group).Separate statistics were conducted on the composition of departments in the reoperation group and the reasons for reoperation.At the same time,the relationship between gender,age,admission method,surgical level,surgical duration,comorbidities,and reoperation of the two groups of cases was analyzed to explore the influencing factors of unplanned reoperation.SPSS 26.0 statistical software was used for data processing.Results The top three departments in terms of unplanned reoperation cases are spinal surgery(36.84%),general surgery(18.42%),trauma orthopedics(10.53%),and orthopedics(10.53%);The main causes of reoperation were postoperative hematoma(42.11%),incision complications(21.05%),poor internal fixation position(7.89%),and nerve injury(7.89%);The results of univariate analysis showed that the reoperation rate of third and fourth level surgeries was significantly higher than that of first and second level surgeries(χ^(2)=14.716),the reoperation rate of surgeries with a duration over 3 hours was significantly higher than that of surgeries with a duration below 3 hours(χ^(2)=46.812),the reoperation rate of those with coronary heart disease was higher than that of those without coronary heart disease(χ^(2)=46.815),and the reoperation rate of those with anemia was higher than that of those without coronary heart disease(χ^(2)=63.451).The above results were all P<0.001,and the difference was statistically significant.Conclusions High level surgery and some complications increased the rate of unplanned return to the operating room f

关 键 词：非计划再手术 术后血肿 围手术期管理 

分 类 号：R197.323[医药卫生—卫生事业管理]