某区域医疗中心近三年非计划再次手术汇总分析

Unplanned reoperation rates in a certain medical center in recent three years

目的分析某区域医疗中心近三年非计划再次手术发生的原因。方法收集2017年1月-2019年12月住院并实施手术的患者中发生非计划再次手术的病例资料,分析相关原因。结果2017年-2019年共统计手术总例数87618例,发生非计划再次手术191例,占比2.18‰,其中例数居前5位的分别是普外科(64例)、神经外科(39例)、肝胆科(14例)、泌尿科(13例)和心胸外科(11例);普外科以胃肠非计划再次手术为主,神经外科以开颅非计划再次手术为主;患者年龄以41~74岁为主;非计划再次手术发生的原因前5位分别为出血或血肿(37.70%)、再次探查手术部位(15.71%)、吻合口瘘(12.57%)、脑水肿或脑积水(10.99%)、感染(5.24%)。结论完善主动监测与上报信息系统,加强院科两级管理,注重原因分析与改进,有利于减少非计划再次手术的发生。

Objective To analyze the unplanned reoperation rates ina certain medical center in recent three years and related influencing factors.Methods The clinical data of unplanned reoperations conducted between January 2017 and December 20149 were retrospectively analyzed,and potential reasons causing reoperation were analyzed.Results There were 191 cases of unplanned reoperations happened,and the unplanned reoperation rate was 2.18‰(191/87618).The five most common types of unplanned reoperations were the general surgery(n=64),neurosurgery(n=39),hepatobiliary surgery(n=14),urology surgery(n=13)and cardiothoracic surgery(n=11).The gastrointestinal surgery was the major type of unplanned general surgery,and the craniotomy was the major type of unplanned neurosurgery.Most of patients with unplanned reoperations were aged between 41 and 47 years old.Potential causes of unplanned reoperations mainly included bleeding and massive hematoma(37.70%),re-exploration for the surgical site(15.71%),anastomotic fistula(12.57%),hydrocephalus and cerebral edema(10.99%)and infection(5.24%).Conclusion It is required to improve the monitoring and reporting system,enhance the hospital-department management and reduce the risk of unplanned reoperations based on the cause analysis.