非计划再次手术关键环节管理与效果分析

目的 探索有效降低非计划再次手术发生率的管理方法。方法 对2012年1月—2016年12月住院并进行手术的患者进行主动监测,加强管理,发现非计划再次手术病例,统计发生率及引发原因。结果 225 944例手术共发生非计划再次手术914例,平均发生率为0.40%且五年呈显著下降趋势。引发原因以手术部位感染、切口裂开、切口疝或愈合不良,术后出血,出现漏或瘘为主,共占73.9%。结论 完善主动监测与报告系统、加强院科两级管理、注重原因分析与改进可有效降低非计划再次手术的发生率。

Effect Analysis of the Key Link of Management of Unplanned Reoperation

Objective To explore the effective method to reduce the incidence of unplanned reoperation. Methods Patients who were hospitalized from January, 2012 to December, 2016 and underwent the surgery were actively monitored. Meanwhile, they had to be managed. The reports of unplanned reoperation were found, and statistical incidence and cause were obtained. Results There were 914 cases of unplanned reoperation in 225 944 cases. The average incidence rate was 0.40%, and there was a significant decreasing trend in the five years. Causes of unplanned reoperation were mainly infection of surgical site, dehiscence of the incision, incisional hernia or poor healing, postoperative bleeding, leakage or fistula, which accounted for 73.9%. Conclusion To improve the active surveillance and reporting system, to strengthen the management of two levels, including the hospital and the department, and to draw attention to reason analysis and the improvement that could effectively reduce the incidence of unplanned reoperation are needed.