集中管理模式下胸外科日间手术患者非计划再就诊影响因素分析

Analysis of Risk Factors of Unscheduled Revisits in Thoracic Surgery Patients Undergoing Ambulatory Surgery under Centralized Management Mode

目的探讨集中管理模式下日间手术的安全性,分析胸外科日间手术患者出院后非计划再就诊影响因素。方法回顾性收集2021年1月-12月某院日间病房患者的基本情况、退出日间比例、围手术期并发症发生率、出院后非计划再就诊等资料,采用单因素和多因素Logistic回归分析法分析胸外科日间手术患者出院后非计划再就诊影响因素。结果2021年1月-12月,日间病房共收治患者1350例,其中1336例(98.96%)完成日间手术管理流程,14例(1.04%)术后转入专科病房继续治疗,患者平均住院时间为(1.28±0.85)d。31例(2.30%)出院后7 d内非计划门急诊就诊,12例(0.89%)出院后30 d内非计划再住院,均集中于胸外科。术后发生Ⅱ级及以上漏气(OR=6.397,P=0.004)是胸外科日间手术患者出院后非计划再就诊的独立危险因素。结论集中管理模式下的日间手术安全可靠,患者出院后非计划再就诊主要集中于胸外科,且与术后漏气密切相关,临床医生需采取措施进行干预。

Objective To explore the safety of ambulatory surgeries under centralized management model and analyze the risk factors of unplanned revisiting of thoracic ambulatory surgery patients.Methods Data of patients in ambulatory ward of a hospital from January to December 2021,such as basic situation,exit ambulatory ratio,perioperative complication rate,and unplanned revisit after discharge,were retrospectively collected.Univariate and multivariate Logistic regression analysis were used to analyze the influencing factors of unplanned revisits after discharge of thoracic surgery patients in ambulatory ward.Results From January to December 2021,a total of 1350 patients were admitted to the ambulatory ward,of which 1336(98.96%)completed the ambulatory operation management process,and 14(1.04%)were transferred to the specialist ward for continued treatment after surgery,with an average length of stay of(1.28±0.85)days.Thirty-one patients(2.30%)had unplanned outpatient and emergency visits within 7 days after discharge,and 12 patients(0.89%)had unplanned re-hospitalization within 30 days after discharge,all of which were mainly concentrated in the department of thoracic surgery.The occurrence of grade II OR above air leakage(OR=6.397,P=0.004)was an independent risk factor for unplanned revisiting after discharge in patients undergoing ambulatory surgery.Conclusion It is safe and reliable to develop ambulatory surgeries under centralized management model.Unplanned hospital revisiting of ambulatory surgeries was mainly concentrated on thoracic surgery patients,which was closely associated with air leak.