基于RCA方法非计划二次手术的相关性研究  

Correlation Study of Unplanned Secondary Surgery Based on RCA Method

作　　者：周俊宏 苏鹏[1] 苏杰[1] 陈妤姗 肖海萍[1] 陈忠岩[1] Zhou Junhong;Su Peng;Su Jie;Chen Yushan;Xiao Haiping;Chen Zhongyan(Foshan Second People's Hospital,Foshan 528000,Guangdong Province,China)

机构地区：[1]佛山市第二人民医院,广东省佛山市528000

出　　处：《中国病案》2025年第1期24-26,共3页Chinese Medical Record

基　　金：佛山市“十四五”高水平医学重点专科项目(FSGSP145067)。

摘　　要：目的 通过分析某三级甲等综合医院非计划二次手术发生情况,探讨降低非计划二次手术发生率,提高医疗质量安全的有效措施及管理方法。方法 收集某三级甲等综合医院2021年1月1日-2023年12月31日138例非计划二次手术的相关数据,对发生率、科室分布、二次手术发生原因等进行统计分析。结果 2021年-2023年全院非计划二次手术发生率0.17%,符合国家标准;非计划二次手术原因构成比排名前5位为术后出血34.78%、首次手术后未取得理想效果19.57%、术后感染14.49%、首次手术意外穿刺伤3.62%、术后吻合口瘘2.9%、术后深静脉血栓2.9%。神经外科、呼吸内科、肝胆胰脾外科、骨科及心内科为非计划二次手术发生率排名前5的科室。结论 高龄手术患者与高难度的手术是非计划二次手术发生的主要影响因素,术后出血与首次手术后未取得理想效果是非计划二次手术发生的主要发生原因,非计划二次手术的发生显著延长了患者的住院时长,给患者带来了额外的负担。医院开展全流程监管措施可有效管控非计划二次手术。Objectives This study aims to analyze the occurrence of unplanned secondary surgeries in a tertiary-level A general hospital, so as to explore effective measures and management methods to reduce the incidence of unplanned secondary surgeries and improve medical quality and safety. Methods Data on 138 unplanned secondary surgeries performed in a tertiary-level general hospital from January 1, 2021 to December 31, 2023 were collected.The incidence, department distribution, and causes of secondary surgery were statistically analyzed. Results The hospital-wide rate of unplanned secondary surgeries from 2021 to 2023 was 0.17%, in line with national standards.The top five reasons for unplanned secondary surgery were postoperative bleeding(34.78%), failure to achieve ideal results after the first surgery(19.57%), postoperative infection(14.49%), accidental puncture injury during the first surgery(3.62%), postoperative anastomotic leakage(2.9%), and postoperative deep vein thrombosis(2.9%).Neurosurgery, respiratory medicine, hepatobiliary, pancreatic and splenic surgery, orthopedics and cardiology were the top five departments with the highest incidence of unplanned secondary surgeries. Conclusions Elderly surgical patients and difficult surgeries are the main factors affecting the occurrence of unplanned secondary surgeries.Postoperative bleeding and failure to achieve ideal results after the first surgery are the main reasons for the occurrence of unplanned secondary surgeries. The incidence of unplanned secondary surgeries is significant. It prolongs the patient's hospital stay and places additional burden on the patient. The hospital's implementation of full-process supervision measures can effectively control unplanned secondary surgeries.

关 键 词：非计划二次手术 医疗质量 手术分级 全流程监管措施 

分 类 号：R197.323[医药卫生—卫生事业管理]