某三级综合医院101例非计划再次手术原因分析及对策

Analysis and Countermeasures of 101 Cases of Unplanned Reoperation in a Comprehensive Hospital of Grade Three

目的研究非计划再次手术的原因,为提高医疗安全、降低非计划再次手术发生率提供依据。方法收集2014年1月1日至2019年1月1日医院发生的101例非计划再次手术,对其手术级别、年龄段、科室分布、原因等进行回顾性统计分析。结果近5年的非计划再次手术发生率为0.21%,其中一、二级手术11例(0.05%),三、四级手术90例(0.35%);患者中神经外科、心外科、胸外科、普外科的非计划再次手术发生率最高,而非计划再次手术发生例数最多的科室是普外科、神经外科、心外科和骨科,占全院非计划再次手术的73.27%。采取相应的整改措施后,2017年和2018年的非计划再次手术发生率下降为0.18%和0.16%,较之前有所下降。结论医院必须强化围手术期制度,加强上报监管,医疗质量管理委员会要充分履行职能,科室及时总结经验教训,以持续改进的形式减少非计划再次手术的发生。

Objective:To study the causes of unplanned reoperation,so as to provide basis for improving medical safety and reducing the incidence of unplanned reoperation.Method:101 cases of unplanned reoperations occurred in the hospital from January 1,2014 to January 1,2019 were collected,and a retrospective statistical analysis was conducted on their surgical grade,age,department distribution and causes.Result:The incidence of unplanned reoperations in recent 5 years was 0.21%,including 11 operation cases of the first and the second degrees(0.05%),and 90 operation cases of the third and the fourth degree(0.35%).Among the patients,neurosurgery,cardiac surgery,thoracic surgery and general surgery had the highest incidence of unplanned reoperation,while the departments with the highest incidence of unplanned reoperation were generally surgery,neurosurgery,cardiac surgery and orthopedics,accounting for 73.27%of the total hospital unplanned reoperation.After taking corresponding corrective measures,the incidence of unplanned reoperations in 2017 and 2018 decreased to 0.18%and 0.16%,lower than before.Conclusion:The hospital must strengthen the perioperative system,the report and supervision;The medical quality management committee should fully perform its functions;The departments should summarize the experience and lessons in time,and reduce the occurrence of unplanned reoperations in the form of continuous improvement.