口腔专科医院非计划二次手术的回顾性分析

Retrospective Analysis of Unplanned Secondary Surgery in Stomatological Hospital

目的探讨口腔专科医院非计划二次手术发生的特点及影响因素。方法选取北京大学口腔医院2016—2021年所有二次手术患者信息,对非计划二次手术的病种、发生原因等进行统计分析,通过logistic回归进一步分析舌恶性肿瘤非计划二次手术的相关性因素。结果2016—2021年共发生非计划二次手术468例(1.17%),与第一次手术的间隔时间为0~20 d。构成比排在前3位的病种为颌面部恶性肿瘤、颌面部良性肿瘤、颌面部感染,导致非计划二次手术的主要原因为皮瓣血管危象、手术后血肿出血,占比为90.17%(422/468)。非计划二次手术组男性319例,女性149例,男女之比为2.14∶1,年龄53.00(36.00,62.00)岁,住院时间14.00(12.00,18.00)d,总费用为68694.91(51773.01,89850.04)元;对照组男性19932例,女性19495例,年龄31.00(18.00,53.00)岁,住院时间7.00(4.00,10.00)d,总费用为12338.96(8869.90,28650.17)元,比较差异有统计学意义(P<0.05)。非计划二次手术术式以有皮瓣为主,占比为76.07%。2016—2021年三四级手术中非计划二次手术发生率为3.62%(397/10966),高于一二级手术的0.25%(71/28929)。年龄、饮酒史、高血压、皮瓣手术是影响舌恶性肿瘤非计划二次手术的主要危险因素(P<0.05)。结论应针对口腔颌面外科专业非计划二次手术危险因素,加强围手术期和手术分级管理,以提升医疗质量。

Objective To explore the characteristics and influencing factors of unplanned secondary surgery in stomatological hospital.Methods The information of all patients with secondary surgery in Peking University School and Hospital of Stomatology from 2016 to 2021 was selected,and the diseases and causes of unplanned secondary surgery were statistically analyzed.The related factors of unplanned secondary surgery for malignant tumor of tongue were further analyzed by logistic regression.Results From 2016 to 2021,a total of 468 cases(1.17%)underwent unplanned secondary surgery.The interval between unplanned secondary surgery and the first operation was 1 to 20 d.The top 3 diseases were maxillofacial malignant tumor,maxillofacial benign tumor and maxillofacial infection.The main causes of unplanned secondary surgery were flap vascular crisis and hematoma bleeding,accounting for 90.17%(422/468).There were 319 males and 149 females with a ratio of 2.14:1,age of 53.00(36.00,62.00)years,duration of hospitalization of 14.00(12.00,18.00)d,and total cost of 68694.91(51773.01,89850.04)yuan of unplanned secondary surgery group.There were 19932 males and 19495 females,aged 31.00(18.00,53.00)years,hospitalization time 7.00(4.00,10.00)d,and total cost was 12338.96(8869.90,28650.17)yuan in the control group,the difference was statistically significant(P<0.05).The unplanned secondary surgery was mainly with flap,accounting for 76.07%.The incidence of unplanned secondary surgery in grade 3 and 4 surgeries from 2016 to 2021 was 3.62%(397/10966),higher than 0.25%(71/28929)in grade 1 and 2 surgeries.Age,drinking history,hypertension and flap operation were the main risk factors for unplanned secondary surgery for tongue malignancy(P<0.05).Conclusions In view of the risk factors of unplanned secondary surgery in oral and maxillofacial specialty,we should strengthen perioperative management,strictly classify surgery,in order to improve medical quality.