一家肿瘤专科医院胃肠外科非计划再次手术78例回顾性分析

Retrospective analysis of 78 cases of unplanned reoperation after gastrointestinal surgery in an oncology hospital

背景非计划再次手术是医疗质量评价体系中的“重返类”指标,可以敏感反映医院外科系统医疗质量.我国《三级综合医院评审标准实施细则》中将其列为评审体系核心指标,要求医院有监测、原因分析、反馈、整改和控制体系.目的探讨一家肿瘤医院胃肠外科非计划再次手术的临床特点和发生原因.方法对新疆肿瘤医院胃肠外科2013-01/2020-12期间78例接受非计划再次手术患者的临床和随访资料进行回顾性分析.结果胃肠外科非计划再次手术的发生率为1.33%(78/5871),与常规手术相比,非计划再次手术患者在性别(χ^(2)=11.695,P<0.01)、首次手术时间(χ^(2)=25.772,P<0.01)、住院时间(χ^(2)=79.355,P<0.01)、住院费用(χ^(2)=76.382,P<0.01)、手术费用(χ^(2)=82.432,P<0.01)、医疗纠纷(χ^(2)=95.289,P<0.01)、病情转归(χ^(2)=52.147,P<0.01)方面有显著性差异,首次手术时间≥180 min(P<0.01)、住院时间≥18 d(P<0.01)是非计划再次手术的独立危险因素.术后并发症是胃肠外科非计划再次手术的直接原因,主要为吻合口瘘(35.90%,28/78)、术后出血(35.90%,28/78)、切口裂开(15.38%,12/78)等.非计划再次手术的死亡率为3.85%(3/78),纠纷发生率为5.13%(4/78).结论非计划再次手术明显延长患者住院时间,增加医疗纠纷,影响病情转归,吻合口瘘、出血、切口裂开等术后并发症是胃肠肿瘤非计划再次手术的主要原因.

BACKGROUND Unplanned reoperation is a“return”index in the medical quality evaluation system,which can sensitively reflect the medical quality of a hospital surgical system.It is listed as the core index of the evaluation system in China’s detailed rules for the implementation of evaluation standards for tertiary general hospitals,which requires hospitals to have a monitoring,cause analysis,feedback,rectification,and control system.AIM To investigate the clinical characteristics and causes of unplanned reoperation after gastrointestinal surgery in an oncology hospital.METHODS The clinical and follow-up data of 78 patients undergoing unplanned reoperation from January 2013 to December 2020 at the Department of Gastrointestinal Surgery of Xinjiang Tumor Hospital were retrospectively analyzed.RESULTS The incidence of unplanned reoperation after gastrointestinal surgery was 1.33%(78/5871).There were significant differences in sex(χ^(2)=11.695,P<0.01),first operation time(χ^(2)=25.772,P<0.01),hospitalization time(χ^(2)=79.355,P<0.01),medical disputes(χ^(2)=95.289,P<0.01),and prognosis(χ^(2)=52.147,P<0.01)between patients who underwent unplanned reoperation and those who underwent conventional surgery.First operation time(≥180 min)(P<0.01)and hospitalization time(≥18 d)(P<0.01)were independent risk factors for unplanned reoperation.Postoperative complications were the direct causes of unplanned reoperation after gastrointestinal surgery.The main causes were anastomotic leakage(35.90%,28/78),bleeding(35.90%,28/78),and wound dehiscence(15.38%,12/78).The mortality rate of unplanned reoperation was 3.85%(3/78),and the rate of disputes was 5.13%(4/78).CONCLUSION Unplanned reoperation significantly prolongs the hospitalization time of patients,increases medical disputes,and affects the prognosis.Postoperative complications such as anastomotic fistula,bleeding,and incision dehiscence are the direct causes of unplanned reoperation for gastrointestinal tumors.