摘要
目的探讨非计划再手术的危险因素,建立预警模型,降低非计划再手术的发生率。方法选取某医院2019年1月1日-2022年12月31日同次住院期间手术次数≥2次的患者信息12786例。根据纳排标准,筛选出289例非计划再手术作为研究组,12497例计划性再手术作为对照组;用单因素和多因素分析的方法,分析非计划再手术的影响因素,R软件构建预测非计划再手术发生的列线图模型,并验证该列线图模型预测效果。结果非计划再次手术的发生率0.17%(289/161554)。单因素分析结果显示,两组在患者年龄、是否患有恶性肿瘤、前次手术方式、前次手术时长、前次主刀医师职称、麻醉分级、手术风险分级、切口等级、前次手术级别,差异有统计学意义(P<0.05);多因素Logistic回归分析结果显示,前次手术时长、患有恶性肿瘤、麻醉等级≥P3、Ⅱ和Ⅲ类切口、前次主刀医师高级职称、三级与四级手术、手术风险等级2级和3级是影响非计划再次手术发生的独立危险因素,而微创手术方式是保护因素(P<0.05)。训练组UR发生风险的ROC曲线下的面积(AUC)为0.879(95%CI=0.7862~0.8589),验证组UR发生风险的AUC为0.831(95%CI=0.7385~0.8489)。Hosmer-Lemeshow校准曲线拟合度较好(训练组P=0.892;验证组P=0.885)。结论非计划再手术的独立影响因素主要包括患者前次手术时长、患有恶性肿瘤、麻醉等级≥P3、Ⅱ和Ⅲ类切口、前次主刀医师高级职称、三级与四级手术、手术风险等级2级和3级、微创手术,基于以上影响因素构建的列线图模型具有较好的灵敏度和特异度,对临床医护人员及时识别高危患者并采取有效干预措施,降低非计划再手术发生具有重要意义。
Objectives This study aims to investigate the risk factors of unplanned reoperations and establish an early warning model to reduce the incidence of unplanned reoperations.Methods Information on 12,786 patients who underwent≥2 surgeries during the same hospitalization period in a hospital from January 1,2019 to December 31,2022 was selected.According to the discharge standard of unplanned reoperations,289 cases of unplanned reoperation were selected as the research group,and 12497 cases of planned reoperation were selected as the control group.Univariate and multivariate Logistic regression analyses were performed to identify the risk factors of unplanned reoperation.R software was used to build a nomogram model for predicting the occurrence of unplanned reoperation and verify the effect of the nomogram model in predicting the occurrence of unplanned reoperation.Results The incidence rate of unplanned reoperation after surgery was 0.17%(289/161,554).The results of univariate analysis showed that there were statistically significant differences in the patient age,malignant tumor,previous surgical method,previous surgical duration,previous chief surgeon title,anesthesia grade,surgical risk grade,incision grade,and previous surgical grade between the two groups(P<0.05).The results of logistic regression analysis showed that the duration of the previous surgery,the presence of malignant tumors,anesthesia grade more than P3,two and three incisions,senior professional titles of the previous chief surgeon,third and fourth level surgeries,two and three surgical risk levels were independent risk factors for the occurrence of unplanned reoperation,while minimally invasive surgery was a protective factor(P<0.05).The area under the ROC curve(AUC)for the risk of unplanned reoperations in the training group of the model was 0.879(95%CI=0.8762-0.8589),and the AUC for predicting the risk of DN in the validation group was 0.831(95%CI=0.7385-0.8489)based on the predictor variables.The Hosmer-Lemeshow calibration curve fit was good(P=0.892 for the training group;P=0.885 for the validation group).Conclusions The independent influencing factors of unplanned reoperation include the length of the patient's previous surgery,the presence of malignant tumors,anesthesia grade more than P3,two and three incisions,senior professional titles of the previous chief surgeon,third and fourth level surgeries,two and three surgical risk level,and minimally invasive surgery.The nomogram model constructed based on the above factors has good sensitivity and specificity and it has great significance for clinical medical staff to promptly identify high-risk patients and take effective intervention measures to reduce the occurrence of unplanned reoperation.
作者
豆娟
赵英英
吴嘉越
胡国勇
范骏翔
Dou Juan;Zhao Yingying;Wu Jiayue;Hu Guoyong;Fan Junxiang(Department of Medical Services,Shanghai General Hospital,Shanghai 200080,China;不详)
出处
《中国病案》
2024年第7期23-28,共6页
Chinese Medical Record
基金
2022年度上海申康医院发展中心临床管理优化项目(SHDC12022622)
2023年度院内医院管理创新课题(02.06.01.23.120)。
