某市级医院普通外科患者超长住院日影响因素分析

Analysis of Factors Associated with Long-Stay Hospitalizations In General Surgery Department of A Municipal Hospita

目的 探讨某院普通外科患者超长住院日影响因素,为有效缩短平均住院日提供参考依据。方法 采用回顾性研究方法,收集某院2017年1月1日-2020年12月31日普通外科患者住院病案首页信息,将住院日大于第95百分位数定义为超长住院,共纳入12512例患者,其中超长住院日患者592例。对研究对象进行统计描述、单因素及多因素logistic回归分析。结果 2017年-2020年普通外科剔除超长住院日患者后,平均住院日减少1.43日。多因素logistic回归分析结果显示,手术(OR=2.975,P<0.001)、B、C、D型病例(OR值分别为2.052,4.092,4.962,P值均小于0.001)、输血(OR=4.570,P<0.001)、年龄(≥65岁,OR=3.627,P=0.014)、住院次数(≥3次,OR=1.569,P=0.012)和疾病分类(肿瘤,损伤、中毒和外因的某些其他后果、其他;OR值分别为3.564,6.341,1.840,P值均小于0.001)是延长患者住院日的危险因素。结论 超长住院日与患者社会和临床因素有关。医院应全面提升医疗服务能力,严格完成临床路径管理,鼓励开展微创手术,积极探索有效统计方法预测住院天数,缩减患者住院日。

Objective In order to effectively reduce the average length of stage,we explored the influencing factors of longest hospitalization in a general surgery department.Methods The data of 12,512 examples including 592 patients with long stay in hospital,according with requirement were statistically and retrospectively analyzed.The information comes from the front pages of medical records from January 1,2017-December 31,2020 in a general surgery department of a hospital,we defined“long stays”as the hospitalizations with a duration superior to 95th percentile.Statistical description,univariate and multivariate logistic regression analysis were performed on the study.Results The average length of stage was reduced by 1.43 days after patients with long-stay were excluded from 2017 to 2020 in a general surgery department.Logistic regression analysis showed that surgery(OR=2.975,P<0.001),case classification of B/C/D(OR values were 2.052,4.092 and 4.962 respectively,and P values were all less than 0.001),blood transfusion(OR=4.570,P<0.001),age(≥65,OR=3.627,P=0.014),number of admissions(≥3,OR=1.569,P=0.012) and disease classification(tumores,certain other consequences of injuries,poisonings and external causes,others,OR values were 3.564,6.341 and 1.840 respectively,and P values were all less than 0.001) were risk factors for prolonged hospital stay.Conclusion Long-stay hospitalizations is related to the sociological and clinical characteristics of patients.Hospitals should comprehensively improve the medical service capacity,strictly complete clinical pathway management,encourage the development of minimally invasive surgery,predict the hospitalization days by actively explore effective statistical methods to shorten the length of hospital stay.