与绕过紧急和紧急手术的局部外科护理相关的临床后果
Mustafa Abid1, Tyler Malone2, Mark Holmes2
1Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
The Journal of surgical research
|October 15, 2025
概括
农村患者绕过当地手术护理,急需全科手术,面临更高的重症监护病房 (ICU) 住院和长时间停留 (LOS) 的风险. 这些结果对绕道的定义方式敏感,影响农村外科手术护理的可获得性.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 农村卫生 农村卫生
- 一般外科 整体外科
背景情况:
- 在农村人口中,当地外科治疗的绕道率很高.
- 农村患者在紧急/紧急的一般外科病情中绕过当地护理的临床影响仍然不清楚.
研究的目的:
- 调查绕过当地外科护理和农村患者紧急/新出现的全科医疗疾病的临床结果之间的关联.
- 确定绕过最近的外科医院 (NSH) 是否会影响死亡率,并发症,ICU入院或长时间停留 (LOS).
主要方法:
- 使用北卡罗来纳州住院患者出院数据 (2016-2019) 的回顾性队列研究.
- 绕道被定义为在NSH以外的其他医院寻求护理,与至少10英里的距离差异.
- 多变量后勤回归分析了与死亡率,并发症,ICU入院和长期LOS的关联;灵敏度分析使用了替代的绕道定义.
主要成果:
- 26.6%的农村患者绕过他们的NSH进行紧急/紧急的整体手术,旅行的中位数为32.5英里.
- 绕道并没有显着与增加死亡率或并发症的几率有关.
- 绕道与急症监护室入院的几率增加 (aOR 1.31) 和长时间的LOS (aOR 1.37) 有关.
结论:
- 农村患者绕过当地手术护理,患有ICU入院和长时间LOS的风险更高.
- 绕道对临床结果的影响,包括死亡率和并发症,取决于所使用的绕道的定义.
相关概念视频
Peripheral Artery Disease V: Postoperative Nursing Management
376
During the postoperative period, it is crucial to focus on maintaining circulation, identifying and managing potential complications, and planning for discharge.Nursing AssessmentVital signs monitoring: Regularly monitor vital signs, including blood pressure, heart rate, respiratory rate, and temperature, to detect early signs of complications such as bleeding and infection.Circulation assessment: Monitor pulses, perform Doppler assessments, and check capillary refill, color, temperature, and...
376
Aneurysm III: Interprofessional Care
255
Aneurysm management involves either conservative medical therapy or surgical intervention, depending on the size and symptoms of the aneurysm. Conservative management is generally reserved for smaller, asymptomatic aneurysms, while larger or symptomatic aneurysms often necessitate surgical repair.Conservative Medical TherapyFor small, asymptomatic aneurysms, particularly abdominal aortic aneurysms (AAA) less than 5.5 centimeters in diameter, conservative medical therapy is recommended. This...
255
Endoscopic Procedures IV: Sigmoidoscopy and Laproscopy
560
Sigmoidoscopy and laparoscopy are distinct medical procedures that enable physicians to internally inspect different parts of the GI tract. Although they serve different purposes, each is essential for diagnosing and, in some cases, treating various medical conditions.
Sigmoidoscopy
Sigmoidoscopy is a diagnostic procedure that uses a flexible sigmoidoscope equipped with a light source and camera to examine the rectum and sigmoid colon. The procedure involves inserting the tube through the anus...
Sigmoidoscopy
Sigmoidoscopy is a diagnostic procedure that uses a flexible sigmoidoscope equipped with a light source and camera to examine the rectum and sigmoid colon. The procedure involves inserting the tube through the anus...
560
Aneurysm IV: Nursing Management
375
Vigilant monitoring for aneurysm rupture is essential for patients undergoing aortic surgery.Preoperative Nursing ManagementContinuously monitor the patient for manifestations of aneurysm rupture, such as pallor, weakness, tachycardia, hypotension, abdominal, back, groin, or periumbilical pain, changes in consciousness, and a pulsating abdominal mass. Regularly assess the patient's peripheral pulses.Instruct the patient to consume a clear liquid diet the day before surgery and administer...
375
Inflammatory Bowel Disease V: Surgical Management
450
Surgical interventions for inflammatory bowel disease (IBD), which includes ulcerative colitis and Crohn's disease, are essential in managing symptoms and addressing complications. The selection of surgical procedures is contingent upon the specific conditions and complications that stem from these illnesses.
Here are some common surgical interventions for IBD:
Here are some common surgical interventions for IBD:
450
Appendicitis-II: Diagnostic Studies and Management
508
Diagnosing and managing appendicitis requires a structured and comprehensive approach that spans from initial assessment to postoperative care. Here is an overview of the process:
Diagnosing Appendicitis
It requires a multifaceted approach, starting with a detailed physical examination to pinpoint the location and nature of the pain and identify any associated symptoms. Laboratory tests play a crucial role. A complete Blood Count (CBC) typically reveals leukocytosis (an increased number of...
Diagnosing Appendicitis
It requires a multifaceted approach, starting with a detailed physical examination to pinpoint the location and nature of the pain and identify any associated symptoms. Laboratory tests play a crucial role. A complete Blood Count (CBC) typically reveals leukocytosis (an increased number of...
508

