预防手术后败血症:在我们的第一个NSQIP项目中,多学科实施各种对策
J Stuart Wolf1, Margaret L Whitney2, Rebekah M Summey3
1Department of Surgery and Perioperative Care, Dell Medical School, Dell Seton Medical Center, University of Texas, Austin, TX.
实施有针对性的干预措施显著降低了接受红细胞输血和开放性伤口的手术患者的术后败血症率. 这项研究强调了有效的策略,以改善患者的治疗结果和减少败血症的发生率.
科学领域:
- 改善外科手术的质量
- 预防传染病 预防传染病
- 患者安全 患者安全
背景情况:
- 手术后败血症带来很大的风险,特别是在接受涉及红细胞 (RBC) 输血和开放伤口的手术的患者身上.
- 国家外科质量改进项目 (NSQIP) 数据库为分析和改善外科结果提供了有价值的数据.
- 鉴定败血症的根本原因对于制定有效的预防策略至关重要.
研究的目的:
- 为了减少特定患者队列中术后败血症的发生率.
- 调查针对关键风险因素的各种反制措施的有效性.
- 改善与输血实践,细胞救援,抗生素使用和伤口管理相关的绩效指标.
主要方法:
- 利用NSQIP数据识别患有术后败血症高风险的患者.
- 成立工作组以解决已识别的根本原因:过度的红细胞输血,有限的细胞救援使用,不适当的抗生素选择和低于最佳的伤口护理.
- 根据根源原因分析,实施了13项不同的对策.
主要成果:
- 干预措施针对的8个过程指标中的7个实现了改进.
- 在手术后败血症的发生率显著降低,从1.56%降至0.59%.
- 败血症率从NSQIP表现的第十个十分位数下降到第一个十分位数.
结论:
- 实施的对策有效地减少了手术后败血症的发生率.
- 针对输血,抗生素和伤口管理实践的多方面的干预措施可以显著提高患者的安全.
- 该研究为旨在预防手术部位感染和败血症的质量改善举措提供了一个模型.
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