上海市某三甲专科医院非计划再次手术原因及影响因素分析

Analysis on the Causes and Influencing Factors of Unplanned Reoperation in a Tertiary Specialty Hospitalin Shanghai

目的 确定非计划再次手术发生的原因与影响因素,提出降低非计划再次手术发生率的对策。方法 依托2021年住院手术患者信息,设计调查问卷,对医生排序的影响因素赋值,算出平均分并按重要性排序,对住院手术患者非计划再次手术的发生进行单因素分析与二元logistic回归分析。结果 非计划再次手术的原因,耳鼻喉科为术后出血与术后感染,眼科为其他首次手术后的并发症、术后未取得理想效果需再次手术以及术后感染,眼耳鼻整形外科为术后未取得理想效果需再次手术。影响因素方面,排名靠前的影响因素为首次手术级别及难度较高、首次手术是复合型手术等较为复杂的手术、患者合并基础疾病、术前评估不到位以及患者年龄。男性、高龄(≥65岁)以及首次手术是三、四级手术的患者更易发生非计划再次手术。结论 强化围手术期管理,建立非计划再次手术智能化管理体系,院科两级共管、提高医务人员重视程度是降低非计划再次手术的重要策略。

Objective To determine the causes and influencing factors of unplanned reoperation,and put forward countermeasures to reduce the incidence of unplanned reoperation.Methods Based on the information of inpatients undergoing surgery in 2021,a questionnaire was designed.Assign values to the influencing factors of doctor ranking,calculate the average score and rank them by importance.Univariate and bivariate logistic regression analysis of unplanned reoperation in hospitalized patients.Results In terms of the direct causes of unplanned reoperation,postoperative bleeding and infection are the main reason for otorhinolaryngology;Other complications after the first operation,Unsatisfied operation and postoperative infection are for ophthalmology;The direct cause of Plastic surgery unplanned reoperation is unsatisfaction and needs to be operated again.The top influencing factors are the level and difficulty of the first operation(Level 3 and 4 operations),the first operation is a complex operation,the patient has basic diseases,preoperative evaluation is flawed and the age of the patient.Male patients,elderly patients(≥65 years old)and patients whose first operation is a third or fourth grade operation are more likely to have unplanned reoperation.Conclusion Strengthening perioperative management,establishing an intelligent management system for unplanned reoperation,co-management beneath hospital and department,improving medical personnels’attention are important strategies to reduce unplanned reoperation.