手术患者超长住院日影响因素分析

Analysis of Influencing Factors on Excessive Length of Hospital Stay for Surgical Patients

目的探讨手术超长住院的影响因素,为核心指标管理提供依据。方法以某三甲医院2019年-2023年住院手术患者作为研究对象,将住院天数大于30天的认定为超长住院病例,以性别、年龄等个人因素为匹配变量,按照1:3的比例进行倾向性得分匹配,通过描述性统计分析、单因素分析、Logistic回归模型对再入院影响因素进行分析。结果手术超长住院患者比例随年份变化呈下降趋势,相关系数-0.41,P<0.001。Logistic回归分析结果显示急诊、其他医疗机构转入、常规手术、介入手术、无菌切口/愈合不良、感染切口/愈合良好、感染切口/愈合不良、有院内感染、术前住院7~13天、术前住院大于14天、出入院科室不一致、术后有并发症是手术超长住院的危险因素;2级手术与3级手术是手术超长住院的保护因素。结论超长住院日呈多因素影响,可通过术前检查院前完成、加强围手术期管理、探索多学科MDT讨论、加强监管等方式加强手术超长住院日的管理。

Objectives This study aims to explore the influencing factors of surgical prolonged hospitalization.Methods The research subjects were patients who underwent surgery in a tertiary hospital from 2019 to 2023.Patients with hospitalization days greater than 30 were identified as long hospitalization medical records.Personal factors such as gender and age were used as matching variables,and propensity score matching was performed in a 1:3 ratio.Descriptive statistical analysis,univariate analysis,and logistic regression models were used to analyze the factors affecting readmission.Results The proportion of surgical patients with excessive length of hospital stay showed a decreasing trend with a correlation coefficient of-0.41(P<0.001)over the years.The results of logistic regression analysis showed that emergency department,transfer from other medical institutions,routine surgery,interventional surgery,sterile incision/poor healing,infected incision/good healing,infected incision/poor healing,presence of hospital infection,preoperative hospitalization for 7~13 days,preoperative hospitalization for more than 14 days,inconsistent admission and exit departments,and postoperative complications were risk factors for prolonged surgical hospitalization.Secondary surgery and tertiary surgery were protective factors for prolonged hospitalization during surgery.Conclusions The management of excessively long surgical hospital stays can be strengthened by completing preoperative examinations before hospitalization,strengthening perioperative management,exploring multidisciplinary MDT discussions,and strengthening supervision.