北京市某医院围手术期死亡原因及影响因素分析

Analysis on the Perioperative Mortality Causes and Influencing Factors in a Hospital in Beijing

目的了解某医院围手术期死亡病例特点及影响因素,为医院加强围手术期管理提供依据。方法回顾性分析某三级甲等医院2020年1月1日-2022年12月31日围手术期死亡病例共计109例,对围手术期死亡病例进行统计分析和研究。结果3年间手术总例数为59543例,发生围手术期死亡病例109例,病死率为0.18%。2022年与2020年和2021年相比,围手术期病死率有下降趋势,χ^(2)=7.2662,P=0.0264。随着年龄段的增加,围手术期病死率增高,χ^(2)=88.1069,P<0.0001。男性围手术期病死率为0.31%,高于女性的0.10%,χ^(2)=35.1557,P<0.0001。4级手术围手术期病死率为0.40%,高于1级~3级手术的0.10%,χ^(2)=62.3797,P<0.0001。急诊手术围手术期病死率为0.88%,高于择期手术的0.13%,χ^(2)=123.1082,P<0.0001。91例占83.49%的死亡病例发生在术后48小时以后,其中急诊手术与择期手术围手术期死亡的死亡时间分布差异无统计学意义。结论高龄、男性、高级别手术、急诊等因素为发生围手术期死亡的高风险因素,也是医院需重点管理点。

Objectives To understand the characteristics and influencing factors of perioperative mortality in a hospital,and provide evidence for strengthening perioperative management.Methods Retrospective analysis of perioperative mortality in a Three A and Tertiary Hospital from January 1st,2018 to December 3l st,2022,and statistical analysis and research on perioperative mortality was conducted.Results From January 1st,2020 to December 31st,2022,there were 109 perioperative deaths.The 3-year perioperative mortality was 0.18%,showing a downward trend(χ^(2)=7.2662,P=0.0264).With the increase of age,the perioperative mortality increased(χ^(2)=88.1069,P<0.0001).The perioperative mortality of males(0.31%)was higher than that of females(0.10%)(χ^(2)=35.1557,P<0.0001).The perioperative mortality of grade 4 surgery(0.40%)was higher than that of grade 1-3 surgery(0.10%)(χ^(2)=62.3797,P<0.0001).The perioperative mortality of emergency surgery(0.88%)was higher than that of elective surgery(0.13%)(χ^(2)=123.1082,P<0.0001).91 cases(83.49%)occurred after 48 hours after operation.There was no significant difference in the distribution of death time between emergency operation and elective operation.Conclusions Advanced age,male,high-level surgery and emergency were high-risk factors for perioperative mortality,which were also the key management points for hospitals.