玻璃体切割手术日间管理模式真实世界研究

A real-world study of an ambulatory management model for vitrectomy surgery

目的观察并初步分析玻璃体切割手术(PPV)开展日间手术管理后运营效能的变化。方法回顾性临床研究。2015年8月至2023年6月于天津医科大学眼科医院日间和(或)住院行微创PPV治疗的10895例患者10895只眼17528例手术纳入本研究。其中,男性5346例5346只眼,女性5549例5549只眼;年龄(57.74±13.15)(0~95)岁。将2015年8月至2018年12月(日间手术初步开展期)3615只眼6381例手术作为对照组;2019年1月至2023年6月(日间手术扩大开展期)7280只眼11147例手术作为观察组。根据日间手术管理模式,将观察组再分为分散管理组(2019年1月至2020年12月)、集中管理组(2021年1月至2023年6月),分别为2905、4375只眼和4646、6501例手术。对比观察不同组间日间手术占比、平均住院日、平均非计划再手术率的变化。组间计量资料比较采用Mann-WhitneyU秩和检验;计数资料比较采用x检验或Fisher精确概率检验。结果观察组、对照组行日间PPV分别为7852(70.44%,7852/11147)、24(0.38%,24/6381)例,平均住院日分别为1(1)、5(3)d;与对照组比较,观察组日间手术占比显著增多(x^(2)=8051.01)、平均住院日显著降低(Z=4536844.50),差异均有统计学意义(P<0.0001)。分散管理组、集中管理组平均住院日分别为2(3)、1(0)d,非计划再手术分别为34(0.73%,34/4646)、171(2.63%,171/6501)例;与分散管理组比较,集中管理组平均住院日明显降低(Z=1436.94)、非计划再手术率明显升高(x^(2)=54.10),差异均有统计学意义(P<0.0001)。结论PPV日间管理模式可显著降低平均住院日,但也会造成非计划再手术率。

Objective eTo evaluate changes in operational effectiveness after the implementation of ambulatory surgical management in pars plana vitrectomy(PPV).Methods A retrospective clinical study.17528 surgeries in 10895 eyes of 10895 patients who underwent minimally invasive PPV on an ambulatory and/or inpatient basis at Tianjin Medical University Eye Hospital from August 2015 to June 2023 were included in this study.Among them,5346 eyes in 5346 cases were male;5549 eyes in 5549 cases were female.The age ranged from 0 to 95 years,with the mean age of(57.74±13.15)years.6381 surgeries in 3615 eyes from August 2015 to December 2018(the initial period of day surgery)were used as the control group;11147 surgeries in 7280 eyes from January 2019 to June 2023(the expanded period of day surgery)were used as the observation group.According to the management mode of ambulatory surgery,the observation group was subdivided into the decentralized management group(January 2019 to December 2020)and the centralized management group(January 2021 to June 2023),with 2905 and 4375 eyes and 4646 and 6501 surgeries,respectively.Changes in the percentage of day surgery,average hospitalization days,and average unplanned reoperation rate were compared.The Mann-Whitney U test was used to compare numerical variables between groups;the chi-square test or Fisher's exact test was used to compare categorical variables.ResultsThe number of cases of daytime PPV performed in the observation group and control group was 7852(70.44%,7852/11147)and 24(0.38%,24/6381)cases,respectively,and the average hospitalization days were 1(1)and 5(3)d.Compared with the control group,the observation group had a significantly higher percentage of day surgery(x^(2)=8051.01)and a considerably lower mean hospitalization day(Z=4536844.50),and the differences were statistically significant(P<0.0001).The mean hospitalization days in the decentralized and centralized management groups were 2(3)and 1(0)d,respectively,and unplanned reoperations were 34(0.73%,34/4646)and 171(2.63%,171/6501)eyes,respectively.Compared with the decentralized management group,average hospitalization days was significantly lower(Z=1436.94)and unplanned reoperation rate was significantly higher(x^(2)=54.10)were significantly lower in the centralized management group,both of which were statistically significant(P<0.0001).Conclusion PPV ambulatory management model can significantly reduce the average hospitalization day,but also results in higher rates of unplanned reoperations.