某综合医院非计划再次手术原因分析及对策

Analysis and countermeasure on the cause of unplanned reoperation of a general hospital

目的通过对非计划再次手术的原因分析,加强非计划再次手术的监管,提高医疗质量。方法对某三级甲等综合医院2013年度发生的40例非计划再次手术患者的临床资料进行回顾性分析。结果 40例非计划再次手术中发生最多的科室是神经外科(8例),其次为肿瘤外科(5例),普外科、心外科(各4例)。非计划再次手术主要发生在三级以上手术,占75.0%。发生非计划再次手术最多的月份是3月份(7例),其次为1月份(5例)、10月份(5例)。非计划再次手术的主要原因是首次手术的主要并发症(术后出血或渗血、刀口裂开或不愈合、术后感染等),占全部原因的75.0%。结论医院应将非计划再次手术作为医疗质量管理的重点,严格手术分级管理与手术医师分级授权制度,不断加强围手术期管理,加强非计划再次手术监测与绩效考核,降低非计划再次手术的发生率。

Objective To analyze the reason of unplanned reoperation and to strengthen it’s supervision and improve the quality of medical care. Methods The clinical data of 40 cases who had experienced unplanned reoperation in a tertiary hospital in 2013 were studied retrospectively. Results Among the 40 cases, most patients came from department of neurosurgery （8 cases）, department of surgical oncology （5 cases）, department of general surgery and department of cardiac surgery （4 cases in each department）. Most of the unplanned reoperations happened in three-level and higher surgery, accounting for 75%. Most of the unplanned reoperations occurred in March （7 cases）, January and October （5 cases in each season）. The main reason for unplanned reoperation was the main complications of the first surgery, such as postoperative bleeding or errhysis, edge crack or not healing, postoperative infection, accounting for 75.0% of all causes. Conclusion The hospital should take unplanned reoperation as the key point of medical quality management, make strict demands on the institutions of classification management of the operations and hierarchical authorization of the surgeons, enhance pre-postoperative management continuously, strengthen monitor and performance evaluation appraisal of the unplanned reoperation, and reduce it’s incidence.