自贡市某三甲综合医院43例非计划再次手术原因分析及对策

Analysis of causes and countermeasures for 43 cases of unplanned reoperation in a tertiary general hospital in Zigong City

目的通过对43例非计划再次手术发生的原因进行分析,制订具有针对性的对策,降低非计划再次手术发生率,保障医疗质量和患者安全。方法对医院2021年1—9月发生的非计划再次手术病例资料进行回顾性分析。结果非计划再次手术发生率前三位科室为神经外科(22.10‰)、消化内科(6.41‰)、胸心大血管外科(5.36‰);导致非计划再次手术发生的主要原因是术后切口或伤口出血、血肿(18.60%)、胸腹盆腔脏器术后出血(13.95%)、术后感染(11.63%);从手术级别来看,四级手术非计划再次手术发生率3.76‰,为所有手术级别中最高;从手术医师职称和患者年龄分布来看,以副主任医师一级手术医师(53.49%)以及45~74岁的患者为最多。结论非计划再次手术的发生与手术难度、患者自身、操作技术和医疗核心制度的落实等因素有关,应重视科室医疗核心制度落实的监管,强化医师技能培训,减少非计划再次手术的发生。

Objective To reduce the incidence of unplanned reoperation and ensure medical quality and patient safety by analyzing the causes of 43 cases of unplanned reoperation and formulating targeted countermeasures.Methods The data of unplanned reoperation cases in the hospital from January to September 2021 were retrospectively analyzed.Results The three departments with the highest incidence of unplanned reoperation were neurosurgery(22.10‰),gastroenterology(6.41‰),and thoracic and cardiovascular surgery(5.36‰).The main causes of unplanned reoperation were postoperative incision or wound bleeding and hematoma(18.60%),postoperative bleeding from thoraco-abdomino-pelvic organs(13.95%),and postoperative infection(11.63%).In terms of surgical level,the incidence of unplanned reoperation was 3.76‰for Level 4 surgery,which was the highest among all surgical levels.According to the professional titles of surgeons and the age distribution of patients,the number of deputy chief surgeons,first-class surgeons(53.49%)and patients aged 45 to 74 years were the most.Conclusion The occurrence of unplanned reoperation is related to the difficulty of surgery,patients themselves,operation technique and the implementation of medical core system,etc.Therefore,the supervision of the implementation of medical core system in the department should be paid attention to,and the skill training for physicians should be strengthened to reduce the occurrence of unplanned reoperation.