基于三级公立医院绩效考核标准的某三甲医院择期手术并发症特征分析  

Complication Analysis of Elective Surgery Patients in a Certain Hospital Based on the Performance Appraisal Framework of Tertiary Public Hospitals

作　　者：温小飘 黄桂凤 Wen Xiaopiao;Huang Guifeng(Department of Information Quality Control,People's Hospital of Guangxi Zhuang Autonomous Region,Nanning 530021,Guangxi Zhuang Autonomous Region,China;不详)

机构地区：[1]广西壮族自治区人民医院信息质控科,广西壮族自治区南宁市530021 [2]广西壮族自治区人民医院医疗管理科,广西壮族自治区南宁市530021

出　　处：《中国病案》2025年第3期68-72,共5页Chinese Medical Record

基　　金：广西壮族自治区卫生健康委员会自筹经费科研课题(Z-A20220076)。

摘　　要：目的分析择期手术并发症情况及影响因素,为加强手术并发症的管理提供依据。方法选取某三甲医院2023年1月1日—2023年12月31日出院,接受了择期手术的患者住院病案首页共35705份。参照三级公立医院绩效考核的统计方法,391例为择期手术并发症患者。采用卡方检验和Logistic回归分析并发症与性别、年龄、是否四级手术、是否微创手术、是否危重、是否疑难、是否死亡、住院天数以及与非计划再次手术的关系。结果2023年择期手术并发症发生率为1.10%。Logistic回归显示手术并发症的发生率在不同性别、年龄、是否微创手术无统计学差异。分别以非四级手术、非危重、非疑难、非死亡患者为参照,手术并发症在四级手术、危重、疑难、死亡患者中的发生风险更高,OR值分别是2.56,2.37,2.40,17.12。住院时间越长,发生手术并发症的风险越高。56.06%的非计划再次手术患者都存在着不同类型的并发症。发生次数最多的并发症是肺部感染与肺机能不全,占所有并发症的26.74%。发生手术并发症例数最多的科室是妇科和心胸血管外科,分别为52例和51例。手术并发症发生率位于前2位的科室是颅脑肿瘤/创伤/功能神经外科和移植科,分别为8.37%和7.17%。结论影响某院择期手术患者并发症的主要因素有手术级别,危重、疑难程度,超长住院日,手术并发症增加了非计划再次手术的几率。医院择期手术并发症的管理应提高四级手术术前多学科讨论完成率及加强手术分级授权管理,关注超长住院日特别是超过30天患者的管理,提升疑难危重病例诊治能力,同时利用信息系统完善对手术并发症的信息监测及反馈机制。Objectives This study aims to analyze the complications of elective surgery and their influencing factors,and provide a basis for strengthening the management of surgical complications.Methods A total of 35,705 front pages of inpatient medical records of patients who were discharged from a tertiary hospital and underwent elective surgery between January 1,2023 and December 31,2023 were selected.According to the statistical method of performance evaluation of tertiary public hospitals,391 cases were patients with complications of elective surgery.The chi-square test and logistic regression were used to analyze the relationship between complications and gender,age,whether it was a level 4 surgery,whether it was a minimally invasive surgery,whether it was critical,whether it was difficult,whether it died,the length of hospital stay,and unplanned reoperation.Results The complication rate for elective surgeries in 2023 was 1.10%.Logistic regression revealed no statistically significant differences in the incidence of surgical complications based on gender,age,minimally invasive surgery.Taking patients who were not undergoing level 4 surgery,were not critically ill,were not complicated,and were not dead as reference,the risk of surgical complications was higher in patients who were undergoing level 4 surgery,were critically ill,were not complicated,and were dead,with odds ratios OR values of 2.56,2.37,2.40,and 17.12,respectively.A longer hospital stay was associated with a higher risk of surgical complications.Among patients who underwent unplanned reoperations,56.06% had various types of complications.The most common complications were lung infection and pulmonary insufficiency,accounting for 26.74% of all complications.The departments with the highest number of surgical complications were gynecology and cardiothoracic and vascular surgery,with 52 and 51 cases,respectively.The departments with the two highest incidences of surgical complications were neurosurgery and transplantation,with incidences of 8.37%and 7.17%,r

关 键 词：手术并发症 择期手术 三级公立医院绩效考核 

分 类 号：R197.3[医药卫生—卫生事业管理]