【摘要】 目的评估某三级医院择期手术非计划再次手术发生率及病死率,并确定与非计划再次手术术后死亡有关的危险因素。方法回顾性分析某院2013年-2018年的择期手术患者临床资料,病例资料分为非计划再次手术非死亡组与死亡组,收集患者相关信息建立数据库,应用SPSS软件进行统计分析,筛选出差异有统计学意义的危险因素,引入Logistic回归模型,找出非计划再手术术后死亡有关的独立危险因素,针对危险因素制定相应对策,为医院手术质量的持续改进提供依据。结果在103 846例择期手术中,非计划再次手术273例,发生率0.26%,主要的重返原因为出血/血肿(45%)、瘘/穿孔(11%);非计划再次手术组病死率显著高于未发生非计划再次手术组(7%vs0.61%);与择期手术非计划再次手术术后死亡有关的危险因素有:身体质量指数(BMI)、合并心脏病/贫血/低蛋白血症、首次手术风险、麻醉分级(ASA)、手术级别、手术医师职称、术后重返手术室时间、手术部位(下腹部、心脏/心脏大血管)、手术类型(食管切除术、胃切除术),其中,合并心脏病、手术部位为心脏/心脏大血管手术、手术类型为食管切除术为择期手术非计划再次手术术后死亡有关的独立的危险因素。结论非计划再次手术对患者预后具有重要影响,与高病死率相关。合并心脏病、手术部位为心脏/心脏大血管手术、手术类型为食管切除术会增加非计划再次手术术后死亡风险。更多还原

【Abstract】 Objective To estimate the rate of unplanned reoperations in a tertiary hospital and the mortality in reoperated patients and to determine factors associated with risk of mortality in these patients. Methods A retrospective survey was conducted on electivesurgery form 2013 to 2018. The case data were divided into Survivors group and nonsurvivors group.Collect patient-related information to establish a database, apply SPSS software for statistical analysis, screen out the risk factors with statistically significant differences, and introduce them into a logistic regression model to identify independent risk factors related to postoperative mortality of unplanned reoperations,and develop corresponding countermeasures for risk factors and provide a basis for continuous improvement of hospital surgery quality. Results Of 103 846 patients who underwent elective surgery, 273(0.26%) required reoperation. The main cause of reoperation were bleeding(45%) and fistula or perforation(11%). Mortality was significantly higher in reoperated patients compared to that of the non-unplanned reoperation group(7% versus 0.61%). Associated risk factors of unplanned reoperations in elective surgery include:body mass index(BMI), combined heart disease, anemia, hypoproteinemia, initial surgery risk, anesthesia classification(ASA), surgical grade, surgeon title, the time to return to the operating room after surgery, the surgical site(lower abdomen, heart or heart large blood vessels), type of surgery(esophageal resection, gastrectomy).Combined heart disease,the surgical site(heart or heart large blood vessels) and type of esophageal resection surgery were independently associated with mortality. Conclusion Unplanned reoperations have important implications for patient outcomes and are related to high mortality. Combined heart disease,the surgical site(heart/heart large blood vessels) and type of esophageal resection surgery can increase risk.更多还原