延误的代价:评估分层手术室分派对患者结果的有效性
Carma Goldstein1, Hannah L Carroll, Jeffrey R Conner
1From the Department of Surgery (C.G., H.L.C., J.J.H.), Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina; Department of Surgery (J.R.C.), Vanderbilt University Medical Center, Nashville, Tennessee; and Department of Surgery (N.T.M.), The Ohio State University, Columbus, Ohio.
The journal of trauma and acute care surgery
|January 29, 2026
概括
及时进入手术室 (OR) 对急性护理手术 (ACS) 患者至关重要. 如果不能达到OR时间目标,特别是在白天,就会显著增加死亡风险,这凸显了有效的患者流动的重要性.
科学领域:
- 外科手术 医疗外科手术
- 患者的治疗结果.
- 医疗保健管理的管理
背景情况:
- 分层的手术室 (OR) 配送系统是根据生理状态和恶化风险对患者进行优先排序的标准.
- 这些系统旨在通过遵守手术干预的定义时间目标来优化患者的结果.
- 这项研究调查了实现这些时间目标对分层OR派遣系统中的患者结果的影响.
研究的目的:
- 评估坚持分层或发布时间目标对急性护理手术 (ACS) 患者结果的影响.
- 为了确定及时的手术干预,根据派遣系统的规定,是否会影响患者的死亡率.
- 分析白天和夜间紧急病例之间结果的差异.
主要方法:
- 在一个单一的学术中心,在9年的时间里,对4544个新出现的ACS病例进行了回顾性审查.
- 对分层调派系统 (E1,E2,E4,E12,Add On/选择性) 合规性和患者结果的分析.
- 病例分层分为白天和夜晚,回归分析控制患者的并发症和休克指数.
主要成果:
- 在白天患者中观察到明显更高的30天死亡率,这些患者错过了OR时间目标 (4.4%对2.5%,p = 0.024).
- 即使经过对共变量进行调整,未能及时到达手术室也是死亡的独立预测因素 (调整后的几率比,2.1;p = 0.014).
- 对于那些错过了OR时间目标的夜间病例,没有发现死亡率的显著差异.
结论:
- 及时的手术干预对于急性护理手术至关重要.
- 在分层派遣系统中未能达到OR时间目标,与死亡风险增加有关,特别是在白天的紧急病例中.
- 遵守OR时间目标对于有效的源控制和防止患者病情恶化至关重要.
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