基于公开的手术部位感染指标遴选研究

Selection of surgical site infection indicators based on transparency

目的为了创新手术部位感染监管方法,遴选适合公开的手术部位感染指标,为实施手术部位感染率的公开提供参考。方法建立由17~20名国内权威专家组成的德尔菲法专家组,通过文献法确定供筛选的手术部位感染指标,专题小组讨论法确定指标的选择标准;采用Likert 5分制法,由专家依据选择标准对指标进行评分;经过两轮专家咨询,用界值法筛选指标,确定适合公开的手术部位感染指标集。结果经过二轮筛选共纳入包括剖宫产手术部位感染率、疝缝术手术部位感染率、乳腺切除术手术部位感染率等13个适合公开的手术部位感染率指标,并且9个选择标准的平均分均>3.5,且变异系数<0.3,总评分在35.50~37.40;其中,9个指标为特定手术的手术部位感染率,占69.2%。结论初步遴选出适合公开的手术部位感染指标集,为实施透明监管这种新的监管方式打下基础。为了提高可比性,手术部位感染指标在公开前还需要进行风险调整。

OBJECTIVE To innovate the supervision method of surgical site infections and select the surgical site infection indicators based on transparency so as to provide guidance for public report of rate of surgical site infections.METHODS The Delphi expert group was composed of 17-20 domestic authoritative experts,the surgical site infection indicators for screening were determined by the literature review,and the selection criteria were determined through panel discussion,the indicators were scored by the experts on the basis of the selection criteria,the indicators were screened by critical value method,and the surgical site infection indicators appropriate to report publicly were determined after two rounds of expert consultation.RESULTS Totally 13 surgical site infection indicators,that were suitable for being published were included after two rounds of screening.including cesarean section surgical site infection rate,herniorrhaphy surgical site infection rate and adenomammectomy surgical site infection rate,The average scores of selection criteria were greater than 3.5,the coefficient of variation was less than 0.3,and the total scores ranged between 35.50 and 37.40.Of the 13 selected indicators,9 were the surgical site infection rates of specific surgeries,accounting for 69.2% .CONCLUSIONThe surgical site infection indicators set suitable for public report are preliminarily selected,which lays the foundation for implementation of the transparent supervision.The risk adjustment of the surgical site infection indicators should be conducted before the public report so as to improve the comparability.