北京市属医疗机构儿童四级手术分级现状研究

Analysis of Current Status for Pediatric Surgery Grading Management of Grade Ⅳ Among Municipal Hospitals in Beijing

目的探索儿童四级手术分级现况,为手术分级建立儿童标准提供依据。方法收集22家市属医疗机构2016年1月1日-2019年12月31日含手术操作信息的224719人次儿童住院病案首页数据,匹配儿童涉及的手术操作名称与北京版V7.0字典库映射至四级目录中手术操作名称,比对医疗机构填报手术操作分级与四级目录的一致性。结果北京版V7.0字典库中儿童涉及的四级手术条目占比19.84%,低于全部四级目录条目占比21.46%。而实际住院病案首页中院级填报为四级而未被四级手术目录纳入的手术条目(即类别3)占比较高(11.8%~19.9%)。排除填报级别错误等因素,14条手术被推荐定级儿童四级手术。结论儿童四级手术实际应用与四级手术目录存在较大差距,建议制订儿童重点手术标准,规范管理手术分级应用。

Objectives To explore the current situation of grade Ⅳ surgery for children, and provide the basis for the establishment of children’s standard for grade Ⅳ surgery. Methods Data on the front page of hospitalized medical records of 224 719 children with surgical operation information from 22 municipal medical institutions from 2016 to 2019 were collected. Names of surgical operations involved by children were matched with the names of surgical operations mapped from Beijing Version 7.0 dictionary database to the grade Ⅳ catalog. Consistency between the surgical operation grades reported by medical institutions and the grade Ⅳ catalog was compared. Results In Beijing Version 7.0 dictionary database, grade Ⅳ operations related to children were accounted for 19.84%, which was lower than 21.46% of total grade Ⅳ catalog entries. However, the number of surgical items(category 3) that were not included in the grade Ⅳ surgical list and submitted as grade Ⅳ on the first page of actual inpatient medical records accounted for a relatively high proportion(11.8%-19.9%). Excluding the factors such as errors in the reporting level, 14 surgeries were recommended as grade Ⅳ surgeries for children. Conclusions There was a critical gap between practical application of grade Ⅳ surgery in children and catalogue of grade Ⅳ surgery. It was suggested to formulate the standard of key surgery for children and standardize the hierarchical application of surgery.