811例非计划再次手术因素分析

Analysis on the Causes and Influencing Factors of 811 cases Unplanned Reoperation

目的通过对非计划再次手术的发生原因及影响因素分析,探讨非计划再次手术的防控措施。方法回顾性分析某三级甲等综合医院2014年-2016年所有外科手术病例,查找发生非计划再次手术的病例,并通过发生率和构成比进行描述性分析。结果发生非计划再次手术的811例,发生率为5.39‰;非计划再次手术男性536例,占66.09%;50岁~70岁年龄组有394例,占48.58%,发生比例高;非计划再次手术主要发生在神经外科(234例,25.38‰)、骨科(165例,6.02‰)及普外科(160例,6.05‰);术后出血、术后感染、脑水肿、脑积水、未达到预期效果再调整为非计划再次手术发生的主要原因,占总原因的75.83%;骨科、整形科以术后感染为第1原因;急诊外科以粘连、梗阻为第1位原因;除肾内科、眼科和疼痛科以调整手术为第1位原因,其余均以术后出血为第1原因。结论加强围手术期质量管理,采用现代化管理方法有针对性进行监管,纳入科室重点管理,是降低非计划再次手术发生率的有效措施。

Objectives By analyzing the causes and influencing factors of non-planned reoperation, to discuss the measures in order to prevent non-planned reoperation. Methods A retrospective analysis was conducted on the clinical data of all surgical patients of a tertiary hospital from 2014 to 2016, it found out the cases of non-planned reoperation, and descriptive analysis was conducted through the rate and constituent ratio. Results There were 811 cases of unplanned reoperation from 2014 to 2016, the incidence of unplanned reoperation was 5.39 ‰;（2） It mainly happened in males（536 cases, 66.09%）, 50 to 70 years of age group（394 cases,48.58%）;（3） The reoperated patients were mainly distributed in the departments of neurosurgery（164 cases, 25.38 ‰）, orthopedics（165 cases, 6.02 ‰） and general surgery（160 cases, 6.05 ‰）;（4） The main causes of non-planned reoperation included postoperative bleeding, postoperative infection, cerebral edema, hydrocephalus, readjust of undesired effect（5） Postoperative infection was the first cause of orthopedics, plastic surgery; adhesions and obstruction was the first cause of emergency surgery, readjust of undesired effect was the first cause of department of Nephrology, Ophthalmology and Pain. Conclusions To strengthen perioperative quality management, include the key indicator of department and adopt modern management methods targeted to carry out supervision were all key means to decrease the incidence of non-planned reoperation.