膝髋关节置换术非计划性暂停手术的原因分析

Analysis on the causes of unscheduled suspensions of knee and hip arthroplasty

目的:分析择期膝、髋关节置换术前非计划性暂停手术的现状和原因,寻找其中的规律和共同性,为进一步优化择期膝、髋关节置换的患者术前管理,提高医疗资源的使用效率提供依据。方法:选择北京大学第三医院骨科2013年9月至2014年8月住院拟择期行膝、髋关节置换手术,但术前因故被暂停手术的病例资料,记录这些病例被暂停手术的原因,对其进行分析。结果:共拟行膝、髋关节置换手术1 146台,其中完成1 003台,因故暂停143台,停手术率达12.5%。暂停手术最常见的原因是心血管系统疾病(31%),其他部位感染(14%),菌尿(13%)和手术适应证不强(11%),其他导致手术暂停的原因还有血液系统检查异常、下肢静脉血栓、肝功能异常、血糖控制欠佳等。在不同性别的患者之间,停手术率差异无统计学意义(男性15.0%,女性11.6%,P=0.149),不同年龄段的患者之间,停手术率差异无统计学意义(≤50岁13.0%,51~65岁11.6%,66~80岁13.3%,>80岁11.1%,P=0.864),但髋关节置换较膝关节置换更易被暂停手术(膝关节置换11.1%,髋关节置换16.1%,P=0.021)。结论:对于择期行膝、髋关节置换的患者进行恰当的术前教育和管理非常重要,通过明确诊断、细致的病史询问和体格检查,以及有针对性的检查化验,尽量避免住院后暂停手术的发生,提高医疗资源的使用效率。

Objective：To analyze and summarize the causes of unscheduled suspension of knee and hip arthroplasty and to provide the method for optimizing the patient＇s pre-operative management and improving the efficiency of medical resources as well as the patient＇s satisfaction.Methods： The data for this report was retrospectively collected from September 2013 to August 2014 in our hospital,from cases of knee and hip arthroplasty that were suspended before the scheduled operation time.Acquisition data from the collected cases including the patients＇ gender,age and the surgical procedure.At the same time,the suspension reasons were recorded and analyzed.All the decisions of suspension was made by the surgeons and the anesthesiologists according to the abnormal result of preoperative examinations,after communicating with the patients and their families and obtaining their understandings.Results： In the collecting period,our department scheduled 1 146 cases of knee and hip arthroplasty,among which 1 003 were completed,143 suspended （12.5% suspension rate）.Among the causes of suspension,the top four common causes were cardiovascular disease （44/143,31%）,other infections （20/143,14%）,bacteriuria （18/143,13%） and inappropriate surgical indication （16/143,11%）.Other causes include surgeon＇s reason,Blood system abnormalities,high inflammatory index,deep vein thrombosis,other diseases uncontrolled,abnormal liver function and poor diabetes mellitus control,etc.For the rate of suspension,there was no significant difference between the patients with different genders （male： 15.0%,and female： 11.7%,P=0.149）,or age （≤50 years： 13.0%;51-65 years： 11.6%;66-80 years 13.3%;〉80 years 11.1%;P=0.864）.However compared with knee arthroplasty,hip arthroplasty had a higher suspension rate （knee arthroplasry 11.1%,hip arthroplasry 16.1%,P=0.021）.Conclusion： It is important to educate and manage the patients before their knee and hip arthroplasty.Through clear diagnosis,detailed medical history analysis careful physical examination,and targeted outpatient examinations and tests for which priority was focused on cardiovascular or other system diseases we could minimize the occurrence of operative suspension post hospitalization,therefore improving the efficiency of the use of medical resources.