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在腹部手术后未能救援的医院变化:全国性的回顾性观察性研究

Knut Magne Augestad^1,2,3, Katrine Damgaard Skyrud⁴, Anne Karin Lindahl³

¹Division of Surgery Campus Ahus, University of Oslo, Oslo, Norway k.m.augestad@medisin.uio.no.

|November 17, 2023

概括

在挪威,腹部手术后的救助失败率 (FTR30) 在过去十年中有所下降,但手术并发症率保持不变. 医院因素不能解释FTR30的变化,强调需要解决系统性问题.

科学领域:

手术结果研究研究.
医疗保健服务研究医疗服务研究
患者安全患者安全

背景情况:

没有救援 (FTR) 是手术护理质量的关键指标.
了解医院FTR的变化对于改善患者的治疗结果至关重要.
之前的研究已经探索了影响FTR的因素,但医院特定的变化需要进一步调查.

研究的目的:

确定挪威腹部手术后30天内未能救出 (FTR30) 的医院变异和重症监护室 (ICU) 特征.
分析十年来FTR30和手术并发症的趋势.

主要方法:

2011年至2021年期间,在挪威52家医院接受腹部手术的598,736名患者进行了一项全国性的回顾性观察研究.
主要结局:FTR30,定义为手术并发症后30天内死亡.
统计分析包括多变量分析,根据患者的特征进行调整.

主要成果:

30天的术后并发症率为30.7%,其中循环崩,心律失常和手术感染最常见.
有1,740名患者 (6.7%) 经历过FTR30. 并发症的严重程度与FTR30.0有很强的相关性.
据估计,FTR30的发病率每年下降0.31个百分点,但手术并发症率并没有相应下降.
驾驶距离到ICU和FTR30之间没有发现任何关联.
在十年内,类似医院之间的FTR30率存在显著差异.

结论:

在对患者特征进行调整后,医院因素无法解释挪威医院FTR30.30中观察到的变异.
全国FTR30措施得到了改善,但并没有同时减少手术并发症.
政策制定者应该专注于医院内的微系统级问题,以解决高FTR30率的问题.

关键词:

的胃肠道瘤.医疗服务管理与管理医疗保健的质量在医疗保健中的质量.

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