集中管理模式下胸外科日间手术患者非计划再就诊影响因素分析
发布人：yaot 发布时间：2023/10/18 9:28:51 浏览次数：605次
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】——邱莉华 徐璐 路子蕴 马倩 许华晔 把赛君 顾小萍 李冰冰
【摘要】目的 探讨集中管理模式下日间手术的安全性，分析胸外科日间手术患者出院后非计划再就诊影响因素。方法 回顾性收集2021年1月-12月某院日间病房患者的基本情况、退出日间比例、围手术期并发症发生率、出院后非计划再就诊等资料，采用单因素和多因素Logistic回归分析法分析胸外科日间手术患者出院后非计划再就诊影响因素。结果 2021年1月-12月，日间病房共收治患者1 350例，其中1 336例（98.96%）完成日间手术管理流程，14例（1.04%）术后转入专科病房继续治疗，患者平均住院时间为（1.28±0.85）d。31例（2.30%）出院后7 d内非计划门急诊就诊，12例（0.89%）出院后30 d内非计划再住院，均集中于胸外科。术后发生Ⅱ级及以上漏气（OR=6.397，P=0.004）是胸外科日间手术患者出院后非计划再就诊的独立危险因素。结论 集中管理模式下的日间手术安全可靠，患者出院后非计划再就诊主要集中于胸外科，且与术后漏气密切相关，临床医生需采取措施进行干预。
【关键词】日间手术；集中管理模式；胸外科；非计划再就诊
中图分类号：R197.323 文献标识码：A
Analysis of Risk Factors of Unscheduled Revisits in Thoracic Surgery Patients Undergoing Ambulatory Surgery under Centralized Management Mode/QIU Lihua,XU Lu,LU Ziyun,et al.//Chinese Health Quality Management，2023,30(9):27-31
Abstract Objective To explore the safety of ambulatory surgeries under centralized management model and analyze the risk factors of unplanned revisiting of thoracic ambulatory surgery patients.Methods Data of patients in ambulatory ward of a hospital from January to December 2021, such as basic situation, exit ambulatory ratio, perioperative complication rate, and unplanned revisit after discharge, were retrospectively collected. Univariate and multivariate Logistic regression analysis were used to analyze the influencing factors of unplanned revisits after discharge of thoracic surgery patients in ambulatory ward.Results From January to December 2021, a total of 1 350 patients were admitted to the ambulatory ward, of which 1 336 (98.96%) completed the ambulatory operation management process, and 14 (1.04%) were transferred to the specialist ward for continued treatment after surgery, with an average length of stay of (1.28±0.85) days. Thirty-one patients (2.30%) had unplanned outpatient and emergency visits within 7 days after discharge, and 12 patients (0.89%) had unplanned re-hospitalization within 30 days after discharge, all of which were mainly concentrated in the department of thoracic surgery. The occurrence of grade II OR above air leakage (OR=6.397, P=0.004) was an independent risk factor for unplanned revisiting after discharge in patients undergoing ambulatory surgery.Conclusion It is safe and reliable to develop ambulatory surgeries under centralized management model. Unplanned hospital revisiting of ambulatory surgeries was mainly concentrated on thoracic surgery patients, which was closely associated with air leak.
Key words Ambulatory Surgeries; Centralized Management Mode; Thoracic Surgery; Unplanned Revisits
Firstauthor's address Nanjing Drum Tower Clinical College of Xuzhou Medical University，Nanjing，Jiangsu,210008，China
日间手术是指患者在24 h内完成入出院的手术及操作［1］。2022年，国家卫生健康委办公厅印发《日间手术推荐目录（2022年版）》（国卫办医函〔2022〕38号），旨在进一步落实《关于推动公立医院高质量发展的意见》相关要求，大力推行日间手术，提高日间手术占择期手术比例，推动分级诊疗制度建设。尽管推荐目录中大多数日间手术属于创伤小、安全性高、恢复快的微创手术，但由于患者住院观察时间短，身心功能尚未完全恢复，部分不良事件会在出院后发生，导致患者非计划再就诊，最终影响患者预后。因此，如何保证日间手术的医疗质量与患者安全，减少不良事件尤其是出院后非计划再就诊发生率，有待医疗机构进一步探索。本研究通过对南京大学医学院附属鼓楼医院江北院区日间病房2021年1月-12月接受日间手术患者的病例资料进行分析，探讨了集中管理模式下日间手术安全情况，分析了胸外科日间手术患者非计划再就诊影响因素。
1 资料与方法
1.1资料来源
回顾性收集该院江北院区日间病房2021年1月-12月接受日间手术患者的病例资料。纳入标准：（1）所患疾病纳入医院日间手术病种；（2）术前检查血常规、肝肾功能、凝血功能等无明显异常。排除标准：（1）心肺功能不全；（2）严重肝肾功能障碍；（3）合并严重感染；（4）有凝血机制障碍及出血倾向；（5）出院后无法得到完善的家庭照护。本研究经过医院伦理委员会批准（批准号：2022-229-02）。
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