脊柱外科30天内非计划再入院原因分析

目的非计划再入院是导致患者负担加重和医疗资源浪费的重要原因,本文的目的是统计本中心脊柱外科30 d内非计划再入院率,分析其原因,探究合适应对策略。方法回顾性收集自2001年7月至2017年7月我院脊柱骨科收治并行手术治疗的14 770例患者病例资料,共筛选出92例出院后30 d内非计划再入院患者,分析在不同年龄、不同性别、不同疾病类型、不同手术部位、不同内植物使用情况下患者再入院原因。结果脊柱外科30 d内非计划性再入院率为0.62%(92/14 770)。其中因神经功能缺陷或恶化再入院46例,因手术部位感染再入院32例,因脑脊液漏再入院6例,因血肿形成再入院5例,因内植物移位再入院2例,因骨水泥渗漏再入院1例。结论脊柱外科30 d内非计划再入院的主要原因是神经功能缺陷或恶化,脊柱外科医生应注重提高手术质量以降低非计划再入院率,避免不良结果的发生。     

髋、膝关节置换患者出院后非计划再入院危险因素及原因

加速康复外科模式通过优化围术期管理措施,使得髋、膝关节置换(THA/TKA)患者术后并发症减少,住院时间明显缩短,但患者出院后再入院率仍居高不下。目前国外对于THA/TKA患者出院后30 d及90 d再入院危险因素及原因研究结论参差不齐,国内尚缺乏相关的研究报道。本文通过对THA/TKA患者出院后非计划再入院危险因素及原因做一综述,为指导临床工作提供依据。     

脊柱外科30d内非计划再手术原因分析

[目的]探讨脊柱外科30 d内非计划再手术原因。[方法]回顾性分析2001年7月~2017年7月本院脊柱骨科收治并行手术治疗的患者共14 770例,分析不同年龄、不同性别、不同疾病类型、不同手术部位、不同内置物使用情况患者再手术原因。[结果] 14 770例接受脊柱手术患者中共有109例发生非计划再手术,其中19例属于出院后再次入院进行再手术,再手术发生率为0.74%。其中因切口并发症再手术41例,因神经功能缺陷或恶化再手术34例,因血肿形成再手术13例,因内置物位置异常再手术10例,因脑脊液漏再手术6例,因引流管残留再手术5例。在初次手术后超急性期(0~1 d)内发生非计划再手术的首要原因为血肿形成,急性期(2~10 d)内发生非计划再手术的首要原因为神经功能缺陷或恶化,亚急性期(11~30 d)内发生非计划再手术的首要原因为切口并发症。[结论]脊柱外科30 d内非计划再手术的主要原因是切口并发症、神经功能缺陷或恶化、血肿形成,应注意优化围手术期管理,提高手术质量,降低非计划再手术率。     

脊柱外科非计划再手术103例原因分析

目的分析脊柱外科非计划再手术的原因并总结经验,为减少非计划再手术的发生提供相应的对策。方法回顾性分析自2013-01—2017-04脊柱外科103例非计划再手术的临床资料,通过手术记录及医院病历信息系统查找非计划再手术患者的基本情况,对数据进行分析及总结,找出导致非计划再手术发生的相关因素,并针对原因提出相应的对策。结果 9 279例手术中出现103例非计划再手术,发生率为1.11%。非计划再手术距初次手术6 h~79 d,平均10.6 d。103例中治愈79例(76.7%),好转21例(20.4%),手术无效3例(2.9%)。术后血肿形成压迫神经、切口感染是非计划再手术的主要原因。结论积极评估患者情况,严格把握手术适应证,严格落实手术分级管理制度,加强外科医师的专业化培训,规范手术操作流程,进行科学管理,对减少脊柱外科非计划再手术至关重要。     

胸外科手术患者出院后90 d内非计划再次入院分析

目的总结分析北京协和医院胸外科手术患者再次入院的发生率、发生时间、主要原因以及再次入院需要承担的经济负担,以期为减少术后患者再次入院提供借鉴。 方法回顾性收集北京协和医院2011至2020年胸外科出院后90 d内非计划再入院患者的临床病历资料。根据手术部位、手术入路和再入院间隔时间进行亚组分析,并对组间差异进行比较。 结果共纳入111名患者。所有患者的90 d和30 d非计划再入院率分别为0.71%和0.55%。非计划再入院的最常见原因是大量胸腔积液（36.9%）、感染（31.5%）、漏气（19.8%）。该研究的总体再入院时间为14（19.3±19.4）d。非计划再入院患者的平均二次住院时间为13.1（12.0）d。住院费用为（19 533.6±18 918.7）元,总体的有创操作率为79.3%。 结论胸外科手术患者的非计划再入院是一个小概率事件。接受食管手术和非微创手术是非计划再入院的危险因素。大量胸腔积液、感染和漏气是所有患者非计划再入院的最常见原因。出院后的第2～3周是再入院风险最高的时间段。计划外的再入院会给患者带来额外的有创伤害、时间成本和经济负担。     

消化道恶性肿瘤患者非计划再手术危险因素及预后转归的相关分析

目的探讨消化道恶性肿瘤患者非计划再手术发生和预后转归的相关因素。方法回顾性分析2014年1月至2017年12月期间上海交通大学医学院附属第九人民医院北部普外科消化道恶性肿瘤发生非计划再手术患者的临床资料,每例再手术患者以1∶3的比例为其选择相似病例作为对照研究。收集患者的基本资料、术前、术中以及术后的相关资料,分析影响消化道恶性肿瘤患者非计划再手术发生和术后死亡的相关因素。结果 2014年1月至2017年12月期间共开展消化道恶性肿瘤手术588例,非计划再手术患者33例(5.6%),8例(24.2%)再手术后死亡。患者术前有慢性基础疾病、既往腹部手术史、ASA分级3～4级、术前存在贫血、初次手术时间≥4 h和术中出血量≥400 mL以及术后并发症发生率与非计划再手术有关(P0.050),且其中有基础疾病、有腹部手术史、有术前贫血、手术时间≥4 h及术中出血量≥400 mL是影响非计划再手术的独立危险因素(P0.050);患者初次手术前有基础疾病、非计划再手术前血红蛋白90 g/L及非计划再手术中出血量≥400 mL与非计划再手术患者术后死亡有关(P0.050),且其中患有基础疾病、非计划再手术前血红蛋白90 g/L及非计划再手术中出血量≥400 mL是非计划再手术患者术后死亡的独立危险因素(P0.050)。结论通过对消化道恶性肿瘤患者非计划再手术发生的独立危险因素进行有效干预可以降低日后临床工作中消化道恶性肿瘤非计划再手术发生率并改善其预后。     

创伤骨科患者非计划再手术原因分析及临床对策

目的 分析医院创伤骨科患者非计划再手术原因,并针对性制定相关对策,有效预防非计划再手术的发生。方法 回顾性分析2021年1月至2023年1月期间2478例创伤骨科患者临床资料,分析患者临床手术方法和基本资料（性别、年龄等）,将非计划再手术患者作为观察组,其余患者为对照组。比较两组患者相关情况,并分析非计划再手术发生的危险因素。结果 非计划再手术者98例,发生率为3.95%。两组患者在手术方法和手术节段、年龄、糖尿病疾病史以及手术部位差异有统计学意义（P<0.05）;手术方法和手术节段、年龄、糖尿病疾病史以及手术部位为创伤骨科患者非计划再手术影响单因素。多因素Logistic回归分析发现年龄和糖尿病疾病史以及手术节段是创伤骨科患者非计划再手术影响独立性危险因素,P<0.05。结论 创伤骨科患者手术后非计划再手术影响因素较多,尤其是年龄和糖尿病疾病史以及手术节段,因此临床要加强对该因素的监测,并针对性完善手术方案,最大程度避免再手术的发生,减轻患者痛苦同时减轻其经济压力,提高患者生活质量。     

人工全关节置换术后非计划再次入院的原因、危险因素及预防分析

目的分析初次行人工全关节置换术(total joint arthroplasty,TJA)患者出院后90 d内非计划再次入院的原因、危险因素以及可预防性。方法回顾性收集2016年6月至2018年6月在本院初次行TJA的患者348例,分为90 d内非计划再入院组和非再入院组,统计样本的术前、临床及出院后资料,用t检验比较两组样本的资料情况是否有统计学意义,再用多变量logistic回归分析再入院组的相关危险因素,最后由专家组分析、判断再入院组的可预防情况。结果初次行TJA患者出院后90 d内非计划再入院率为5.7%,主要原因为僵硬、脱位、伤口感染等,其中8例是可预防的。两组患者资料显示:身体质量指数(body mass index,BMI)、察尔森共病指数(charlson comorbidity index,CCI)、支付方式、学历水平比较差异有统计学意义。多变量Logistic回归分析结果表明,患者BMI、CCI是出院后90 d内非计划再入院的危险因素。结论对患者进行严格术前筛选、评估,优化患者术中、术后的治疗措施,正确的引导患者术后康复训练,才能更好识别危险因素、减少并发症,进而降低非计划再入院率。     

胃癌根治术后非计划再次手术的原因和危险因素分析

目的通过对病例资料的回顾性研究分析胃癌根治术后非计划再次手术的原因和危险因素。方法回顾性分析2012年1月至2017年12月在南京大学医学院附属鼓楼医院行胃癌根治术(包括开腹和腹腔镜)的病人资料,纳入标准:(1)年龄18～80岁;(2)胃镜病理明确诊断胃癌;(3)接受D2胃癌根治术(包括开腹和腹腔镜手术)。排除标准:(1)胃癌术中行联合脏器切除术;(2)残胃癌行胃癌根治术。共统计胃癌手术病人3 213例,其中接受非计划再次手术病人37例。按照性别、年龄进行1∶2配对,以胃癌术后未接受再次手术的病人为对照组,开展回顾性配对研究,查找非计划再次手术的原因,同时分析导致发生非计划再次手术的危险因素。结果术后行非计划再次手术的中位时间为1d(0～9d),开腹术后31例,腹腔镜术后6例。手术原因包括:腹腔出血(23例,62.2%);吻合口出血(3例,8.1%);吻合口漏(3例,8.1%);切口裂开(2例);肠梗阻(2例);十二指肠残端漏(1例);急性胆囊炎(1例);脾梗死(1例);切口感染(1例)。单因素分析结果显示,非计划再次手术组与对照组的病人在术中出血量(P=0.014)、第一助手资格(P=0.042)方面差异有统计学意义,手术时间、主刀医生资格、手术开始时间、术中输血、手术方式、手术部位等方面差异无统计学意义。多因素Logistic回归分析显示:术中出血量≥200ml是非计划再次手术的独立危险因素(OR=1.827,95%CI:1.034,3.026,P=0.024)。结论腹腔出血是胃癌根治术后非计划再次手术的最常见原因,术中出血量≥200ml是非计划再次手术的独立危险因素。     

腰椎间盘切除术后1年内非计划再入院影响因素分析

目的 探讨腰椎间盘切除术后1年内非计划再入院的影响因素,为其预防提供理论依据。方法 纳入2015年10月-2018年10月于本院接受经皮内窥镜下腰椎间盘切除术(percutaneous endoscopic lumbar discectomy,PELD)的患者167例,随访1年,其中13例于术后1年内非计划再入院,设为观察组;余154例患者设为对照组。收集两组患者临床资料,采取单因素分析和多因素Logistic回归分析确定术后1年内非计划再入院的独立危险因素。结果 两组患者在性别、吸烟史、高血压史、冠心病史、慢性肾脏疾病史、椎间盘突出分型、腰椎失稳、手术时间、术后住院时间等方面比较,差异无统计学意义(P0.05);在年龄、BMI指数、饮酒史、糖尿病史、慢性呼吸道疾病史等方面比较,差异有统计学意义(P0.05)。多因素Logistic回归分析显示,年龄≥55岁(OR=1.852)、BMI指数≥24 kg/m~2(OR=1.541)、糖尿病史(OR=7.620)是腰椎间盘切除术后1年内非计划再入院的独立危险因素(P0.05)。结论 年龄≥55岁、BMI指数≥24 kg/m~2、合并糖尿病的PELD患者,术后1年内非计划再入院的概率较高,临床应加以重视。     

Incidences,causes and risk factors of unplanned reoperations within 30 days of spine surgery: a single-center study based on 35,246 patients

BACKGROUND CONTEXTUnplanned reoperation, a quality indicator in spine surgery, has not been sufficiently investigated in a large-scale, single-center study.PURPOSETo assess the incidences, causes, and risk factors of unplanned reoperations within 30 days of spine surgeries in a single-center study.STUDY DESIGNRetrospective observational study.PATIENT SAMPLEA cohort of 35,246 patients who underwent spinal surgery in our hospital were included.OUTCOME MEASURESThe rates, chief reasons, and risk factors for unplanned reoperations within 30 days of spine surgery.METHODSWe retrospectively analyzed the data for patients who underwent spine surgeries for degenerative spinal disorders, tumor, or deformity and had subsequent unplanned operations within 30 days at a single tertiary academic hospital from January 2016 to July 2021. Univariate and multivariate analyses were performed to assess the incidences, causes, and risk factors.RESULTSOut of 35,246 spinal surgery patients, 297 (0.84%) required unplanned reoperations within 30 days of spine surgery. Patients with a thoracic degenerative disease (3.23%), spinal tumor (1.63%), and spinal deformity (1.50%) had significantly higher rates of reoperation than those with atlantoaxial (0.61%), cervical (0.65%), and lumbar (0.82%) degenerative disease. The common causes for reoperation included epidural hematoma (0.403%), wound infections (0.148%), neurological deficit (0.108%), and pedicle screw malposition (0.077%). Unplanned reoperations were classified as hyperacute (45.45%), acute (30.98%), subacute (15.82%), or chronic (7.74%). Univariate analysis indicated that 20 clinical factors were associated with unplanned reoperation (p<.05). Multivariate Poisson regression analysis revealed that anemia (p<.001), osteoporosis (p=.048), ankylosing spondylitis (p=.008), preoperative foot drop (p=.011), deep venous thrombosis (p<.001), and previous surgical history (p<.001) were independent risk factors for unplanned spinal reoperation.CONCLUSIONSThe incidence of unplanned spinal reoperations was 0.84%. The chief common causes were epidural hematoma, wound infections, neurological deficit, and pedicle screw malposition. Anemia, osteoporosis, ankylosing spondylitis, preoperative foot drop, deep venous thrombosis, and previous surgical history led to an increased risk of unplanned reoperation within 30 days of spine surgery.     

Rates and risk factors associated with unplanned hospital readmission after fusion for pediatric spinal deformity

Background Context

Short-term readmission rates are becoming widely used as a quality and performance metric for hospitals. Data on unplanned short-term readmission after spine fusion for deformity in pediatric patients are limited.

肾移植患者非计划性再入院现状及影响因素调查分析

目的了解肾移植患者非计划性再入院现状及其影响因素,为针对性干预提供参考。方法对肾移植术后1年内的424例患者进行17项相关影响因素的调查分析。结果 85例于出院1年内非计划性再入院,占20.0%;Logistic回归分析显示并发症个数、估算肾小球滤过率(eGFR)及住院期间其他手术是肾移植患者非计划性再入院的危险因素(OR=2.098～2.968;P0.05,P0.01)。结论肾移植患者术后1年内非计划性再入院不容忽视;护理人员应对出院患者进行持续随访和动态评估,及时发现风险因素进行有效干预,同时要特别加强同期行其他手术、并发症较多及eGFR低患者的管理,以降低再入院风险。     

Retrospective analysis of 30-day unplanned readmission after major abdominal surgery with reversal by sugammadex or neostigmine

Background

Sugammadex is associated with fewer postoperative complications, but its impact on 30-day unplanned readmission is unclear.

Patterns of readmission and reoperation within 90 days after Roux-en-Y gastric bypass

BackgroundHealth insurance payors harbor concerns regarding the cost of bariatric procedures that are chiefly related to early readmissions and reoperations. We have attempted to identify the avoidable causes of readmission.MethodsWe retrospectively reviewed the indications for short-term (<90-d) emergency department (ED) visits, readmissions, and reoperations from August 2004 through May 2007 for patients undergoing primary Roux-en-Y gastric bypass (RYGB) for morbid obesity at a tertiary care teaching hospital. The electronic medical record of the primary hospital was reviewed, as well as the electronic medical records of 9 local hospitals serving the area, allowing the incorporation of data from 35 locoregional hospitals.ResultsA total of 1222 consecutive patients underwent RYGB, 1051 laparoscopically. Of these 1222 patients, 173 had 252 ED visits, readmissions, and/or reoperations; 147 (58%) visits were to the primary institution and 105 (42%) occurred at a local or regional hospital. No age difference was found between the patients who underwent ED visits, hospital readmissions, or reoperations and those who did not (mean age 43 yr for both groups, P > .05). Patients who were seen in the ED, readmitted to the hospital, or underwent reoperation had had a greater body mass index (50 kg/m² versus 48 kg/m², P = .001). On average, the readmissions occurred 27.3 days (range 2–88) postoperatively, and the mean hospital length of stay for readmitted patients was 3.3 days (range 1–16). Patients who presented for ED visits, readmission, or reoperations were more likely to have undergone open RYGB than laparoscopic RYGB (P = .002). The <90-day all-cause ED visit, readmission, and reoperation rate was 21% (n = 252). Considering all 1222 patients, the incidence of nausea, vomiting, and dehydration, abdominal pain, and wound issues was 5% (n = 65), 4% (n = 50), and 2% (n = 21), respectively. Considering only the 173 patients with ED visits, readmissions, or reoperations (n = 252), the admitting diagnosis was nausea, vomiting, and dehydration in 26%, abdominal pain in 20%, and wound issues in 8%. The unemployed, disabled, or retired were more likely to have been seen in the ED or readmitted compared with the employed, nondisabled, or not retired (P = .01).ConclusionA considerable number of patients are affected by nausea, vomiting, and dehydration, abdominal pain, and wound issues <90 days postoperatively. Socioeconomic and functional status might have an effect on the rate of ED visits and readmissions. By ensuring that the appropriate outpatient mechanisms for management of these problems are available, early ED visits and readmission rates should significantly decrease.