外科医生对紧急腹部手术的优先考虑及其对术后结果的影响
Severin Gloor1, Antonio Wyss1, Daniel Candinas1
1Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland.
Langenbeck's archives of surgery
|May 7, 2025
概括
在紧急一般腹部外科手术 (EGS) 中遵守外科选方案显著影响患者的结果. 违反协议增加了关键疾病 (如肠道缺血症) 的死亡率,但改善了不那么严重的病例的结果,突出了需要精确的分拣策略的需要.
科学领域:
- 手术结果和患者安全.
- 医疗保健管理和分拣系统
- 紧急医疗和重症监护
背景情况:
- 紧急一般腹部手术 (EGS) 具有高发病率和死亡率的风险.
- 有效的分类系统和及时的手术干预对于改善EGS患者的治疗结果至关重要.
- 这项研究研究了外科医生优先考虑和遵守选方案对术后结果的影响.
研究的目的:
- 评估外科医生遵守分拣方案对紧急一般腹部外科手术中术后结果的影响.
- 分析分拣水平,协议违规,患者发病率和死亡率之间的相关性.
- 识别选决策中的潜在改进,以提高患者安全和资源利用.
主要方法:
- 在一个中心接受EGS的1947名患者的回顾性分析 (03/2015-12/2022).
- 根据手术的紧急性 (1-24小时),患者被分配到分组级别 (1-4).
- 协议违规被定义为延迟超过分拣水平;主要终点是并发症率 (Clavien-Dindo).
主要成果:
- 与较低水平 (1和2) 相比,较高的分拣水平 (3和4) 与明显较低的并发症和死亡率相关.
- 在患有肠道缺血或腹部的患者中,违反协议增加了死亡率.
- 违反协议导致在某些情况下延长住院时间 (HLOS),但在其他情况下改善了结果 (例如,急性 inguinal ).
结论:
- 外科医生的选水平与EGS患者的死亡率和发病率有很强的相关性.
- 违反协议会对关键情况的结果产生负面影响,但可能有利于不那么紧急的情况.
- 将客观参数纳入选决策可以提高EGS的优先级准确性,患者安全性和资源效率.
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