逆行肾内输尿管软镜碎石日间手术患者非计划重返院的多因素Cox生存分析  

Multivariate Cox survival analysis of unplanned readmissions in patients undergoing retrograde intrarenal surgery for day surgery

作　　者：李瑜 黄莉燕[1] 秦丽媛 秦梅彬 LI Yu;HUANG Li-yan;QIN Li-yuan;QIN Mei-bin(Department of Urology,the First Affiliated Hospital of Guangxi Medical University,Nanning 530021,Guangxi,China)

机构地区：[1]广西医科大学第一附属医院泌尿外科,广西南宁530021

出　　处：《广东医学》2024年第11期1425-1428,共4页Guangdong Medical Journal

基　　金：广西壮族自治区卫生健康委员会自筹经费科研课题(Z20190819)。

摘　　要：目的探讨并分析逆行肾内输尿管软镜碎石术(retrograde intrarenal surgery,RIRS)日间手术患者出院非计划返院的影响因素,为临床实施RIRS日间手术出院患者延续护理提供经验和依据。方法收集2021年5月至2023年6月行RIRS日间手术出院患者共234例,将出院患者分为正常组(出院后30 d内无因本手术相关住院)219例和非计划返院组(出院后30 d内因为相关或者相同疾病非计划重新入院)15例,通过单因素及多因素Cox回归分析逐步筛选出独立影响因素。结果本研究非计划重返院发生率为6.41%。多因素Cox回归分析结果:手术时长[风险比(HR)=1.023,95%CI:1.001~1.045,P=0.039]、术后感染(HR=1.162,95%CI:1.023~1.321,P=0.021)、术中出血(HR=0.953,95%CI:0.921~0.987,P=0.006)均是RIRS日间手术术后发生非计划重返院的危险因素。结论降低手术时长;积极控制和预防术后感染;做好出院患者的延续护理,可以有效预防患者因活动不当引发的迟发出血,可以预防逆行肾内输尿管软镜碎石日间手术患者非计划重返院的发生。Objective To investigate and analyze the factors influencing unplanned readmissions in patients discharged after retrograde intrarenal surgery(RIRS)for stone removal in a day surgery setting.This study aims to provide clinical insights and evidence for post-discharge continuous care in patients undergoing RIRS.Methods A total of 234 patients who underwent RIRS as day surgery and were discharged between May 2021 and June 2023 were included in the study.Patients were categorized into two groups:the normal group(n=219,with no readmissions related to the surgery within 30 days post-discharge)and the unplanned readmission group(n=15,with unplanned readmissions due to related or identical conditions within 30 days post-discharge).Univariate and multivariate Cox regression analyses were performed to identify independent influencing factors.Results The incidence of unplanned readmissions was 6.41%.Multivariate Cox regression analysis revealed that longer surgery duration[hazard ratio(HR)=1.023,95%confidence interval(CI)=1.001-1.045,P=0.039],postoperative infection(HR=1.162,95%CI=1.023-1.321,P=0.021),and intraoperative bleeding(HR=0.953,95%CI=0.921-0.987,P=0.006)were independent risk factors associated with unplanned readmissions after RIRS day surgery.Conclusion Reducing surgery duration,proactively preventing and managing postoperative infections,and providing comprehensive post-discharge care can effectively prevent unplanned readmissions in RIRS day surgery patients.Continuous care post-discharge is essential in preventing complications such as delayed hemorrhage due to inadequate activity,thereby reducing the likelihood of unplanned readmissions.

关 键 词：逆行肾内输尿管软镜碎石 日间手术 非计划重返院 多因素Cox生存分析 

分 类 号：R691.4[医药卫生—泌尿科学] R473.6[医药卫生—外科学]