监测和评估手术护理:确定术后死亡率和标准化数据收集
Charlotta L Palmqvist1, Roshan Ariyaratnam2, David A Watters3
1Department of Clinical Sciences in Lund, Paediatric Surgery and Global Paediatrics, Faculty of Medicine, Lund University, Lund, Sweden; The Alfred Hospital and Monash University, Melbourne, VIC, Australia.
Lancet (London, England)
|August 28, 2015
概括
术后死亡率 (POMR) 可以在没有复杂的系统的情况下计算,使用医院内死亡和手术作为分母. 标准化数据收集对于精确的手术结果监测至关重要.
科学领域:
- 手术成果研究
- 卫生信息学
- 公共卫生监测
背景情况:
- 术后死亡率 (POMR) 和病例数量对于外科服务监测至关重要.
- 缺乏用于POMR测量的标准化方法,包括时间,分母和风险调整.
- 需要对各种手术数据集进行分析以解决这些局限性.
研究的目的:
- 分析来自不同资源的四大手术数据集.
- 解决POMR测量的标准化方面的挑战.
- 推一个最低数据集,以便收集一致的数据.
主要方法:
- 使用了来自新西兰,澳大利亚,南非和巴布亚新几内亚的数据.
- 评估数据的完整性,日期错误和编码标准.
- 使用住院和30天死亡率以及入院与手术相比的POMR计算为分母.
- 为风险调整分析进行了后勤回归.
主要成果:
- 包括超过130万次入院和150万次手术; 30天内死亡8655人.
- 观察到数据库完整性和编码标准的显著差异.
- 住院POMR低估了30天的POMR;分母选择影响了结果的10-70%.
- 年龄和紧急住院显著影响了POMR,但风险调整对相对位置概率的影响很小.
结论:
- 医院可以在没有先进电子系统的情况下收集病例数量和POMR的基本数据.
- 由于数据有限,建议使用医院POMR作为分母.
- 包括标准,定义和数据准确性 (特别是日期) 的标准化至关重要.
- 一个简单的,标准化的数据收集表格可以改善全球的POMR监测.
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