Egorova Natalia N, Moskowitz Alan, Gelijns Annetine, Weinberg Alan, Curty James, Rabin-Fastman Barbara, Kaplan Harold, Cooper Mary, Fowler Dennis, Emond Jean C, Greco Giampaolo
InCHOIR-International Center for Health Outcomes and Innovation Research, Department of Surgery, Columbia University, 600 W. 168th Street, New York, NY 10032, USA.
Ann Surg. 2008 Jan;247(1):13-8. doi: 10.1097/SLA.0b013e3180f633be.
Preventing retained foreign bodies is critical for patient safety. However, the value of counting surgical instruments and the reliability of the information provided have never been quantified. This study examines the diagnostic characteristics of counting and its impact on surgical costs.
We examined data from the Medical Event Reporting System-Total HealthSystem (MERS-TH), administrative hospital, and the New York State Cardiac Surgery Report databases (2000-2004). The cost per count discrepancy was examined by studying a cohort of patients undergoing coronary artery bypass graft (CABG) surgery. Linear and logistic multivariable regression models were used for statistical analysis.
Of 153,263 operations, there were 1062 count discrepancies. The rate of retained items was 1 of 7000 surgeries or 1 of 70 discrepancy cases. Final count discrepancies identified 77% and prevented 54% of retained items. The sensitivity of counting was 77.2%, specificity was 99.2%, but the positive predictive value was only 1.6%. Count discrepancies increased with surgery duration, late time procedures, and number of nursing teams. Bypass time, intravenous nitroglycerin injections, or myocardial infarction in the previous 24 hours were independent predictors of count discrepancies in CABG surgery. The incremental OR cost for CABG because of a count discrepancy was $932. Nationally, this would amount to an additional $24 million/yr in OR CABG cost.
This study, for the first time, quantifies the diagnostic accuracy of counting and defines the parameters against which alternative strategies of prevention should be measured, before being adopted in standard practice.
预防异物残留对患者安全至关重要。然而，手术器械清点的价值以及所提供信息的可靠性从未被量化过。本研究旨在探讨器械清点的诊断特征及其对手术成本的影响。
我们研究了医疗事件报告系统-全健康系统（MERS-TH）、医院管理数据以及纽约州心脏手术报告数据库（2000 - 2004年）中的数据。通过研究一组接受冠状动脉旁路移植术（CABG）的患者，来分析每次清点差异的成本。采用线性和逻辑多变量回归模型进行统计分析。
在153,263例手术中，有1062次清点差异。异物残留率为7000例手术中有1例，或70例差异情况中有1例。最终清点差异识别出77%的异物残留并预防了54%的异物残留。清点的敏感性为77.2%，特异性为99.2%，但阳性预测值仅为1.6%。清点差异随着手术时间、晚期手术以及护理团队数量的增加而增加。搭桥时间、静脉注射硝酸甘油或前24小时内发生心肌梗死是CABG手术中清点差异的独立预测因素。由于清点差异导致的CABG手术额外成本为932美元。在全国范围内，这将使每年CABG手术的手术室成本额外增加2400万美元。
本研究首次量化了器械清点的诊断准确性，并确定了在标准实践中采用替代预防策略之前应衡量的参数。
