非计划再次手术原因及影响因素分析  

Analysis of the causes and influencing factors of unplanned reoperations

作　　者：曾茜 区家茵 陈燕红 张斯斯 何基琛 唐耘天[1] ZENG Qian;OU Jiayin;CHEN Yanhong;ZHANG Sisi;HE Jichen;TANG Yuntian(Department of Medical Affairs,The People’s Hospital of Guangxi Zhuang Autonomous Region,Nanning 530021,China;Department of Case Information Management,The People’s Hospital of Guangxi Zhuang Autonomous Region,Nanning 530021,China;Department of Spine Surgery,The People’s Hospital of Guangxi Zhuang Autonomous Region,Nanning 530021,China)

机构地区：[1]广西壮族自治区人民医院医务部,南宁530021 [2]广西壮族自治区人民医院病案信息管理科,南宁530021 [3]广西壮族自治区人民医院脊柱外科,南宁530021

出　　处：《中国医科大学学报》2025年第2期144-149,共6页Journal of China Medical University

基　　金：广西壮族自治区卫生健康委员会自筹经费科研课题(Z20210457)。

摘　　要：目的 探讨非计划再次手术的原因及影响因素,为降低非计划再次手术率提供参考依据。方法 通过提取广西壮族自治区某三级甲等医院2022年1月至12月的手术资料,对该院非计划再次手术的一般情况、科室分布、主要原因以及患者的转归情况进行描述性分析,利用二分类logistic回归分析其影响因素。结果 该院2022年全年非计划再次手术共130例,发生率为0.35%。非计划再次手术患者以男性为主(63.08%),手术切口类型以0类切口为主(46.92%),手术等级以三、四级为主(80.77%),术者职称以副高级以上职称为主(88.46%)。常见原因为术后出血、未达到应有效果、病情需要、探查发病原因、出现漏或瘘,占50.00%。影响因素主要为性别、手术切口类型及手术切口愈合等级,其中男性(OR=1.733,P=0.006)、Ⅰ类手术切口(OR=2.909,P=0.004)及手术切口乙级愈合(OR=6.565,P <0.001)的患者更容易发生非计划再次手术。结论 医院应重视非计划再次手术的监管,针对围手术期存在的问题进行原因分析并持续改进,保障手术质量及患者安全。Objective To investigate the causes and factors affecting unplanned reoperation,and to provide a reference basis for reducing the incidence of unplanned return of the patient to the operating room for reoperation.Methods Surgical data from the hospital was extracted spanning from January to December 2022,and subjected to a descriptive analysis of the overall situation,departmental distribution,primary reasons,and patient referrals related to unplanned reoperations in the hospital,and analyzed factors contributing to unplanned reoperations in the hospital using binary logistic regression.Results In 2022,130 unplanned reoperations were reported in this hospital,corresponding to an incidence of 0.35%.Patients who required unplanned reoperation were predominantly male(63.08%).The majority had surgical incision grade of category 0(46.92%),and surgeries were classified as levels 3 and 4(80.77%).Furthermore,88.46% of the surgeries were performed by surgeons with advanced degrees or higher.The common causes were postoperative bleeding,failure to achieve the desired result,need for the condition,probing for the cause,and occurrence of leakage or fistula,collectively accounting for 50.00% of the cases.Key factors contributing to unplanned reoperations were sex,type of surgical incision,and incision healing grade;among which male patients(OR = 1.733,P = 0.006),patients with classⅠsurgical incision(OR = 2.909,P = 0.004),and patients with incision grade B healing(OR = 6.565,P < 0.001) showed a higher propensity for unplanned reoperations.Conclusion Hospitals should emphasize monitoring and managing unplanned reoperations by improving perioperative supervision,conducting thorough root cause analyses,and focusing on continuous quality improvement to enhance surgical outcomes and patient safety.

关 键 词：非计划再次手术 监测 影响因素 

分 类 号：R197.323.2[医药卫生—卫生事业管理]