Department of Surgery, Clinical Research Institute, Universidad Nacional de Colombia, Bogotá, Colombia.
J Surg Res. 2013 Jun 1;182(1):11-6. doi: 10.1016/j.jss.2012.07.060. Epub 2012 Aug 11.
Unplanned reoperations have been proposed as a quality indicator in surgery but have not been studied extensively, especially concerning risk factors.
This was a prospective cohort study in a third-level general surgery service. Data regarding patients operated on between July 2007 and February 2008 and followed up for 30 postoperative days were collected. Unplanned reoperations were the primary end point. The secondary end points were 30-d mortality and length of stay. A multivariate logistic regression analysis evaluated the hypothesis that patients operated on in emergency conditions had a greater chance of being reoperated on, after adjusting for relevant covariates.
There was a 5.9% cumulative incidence of unplanned reoperations. Patients operated on in emergency conditions had a 1.79 crude relative risk (RR) (95% confidence interval [CI], 1.15-2.78) of reoperation. Reoperated patients' RR of mortality was 8.94 (95% CI, 6.11-13.07). The mean postoperative hospital stay was 3d for patients who were not reoperated on and 19d for those who were reoperated on (P=0.00001). The logistic regression model gave a 2.83 odds ratio (95% CI, 1.65-4.87) for reoperation on emergency patients when adjusted for age, gender, body mass index, American Society of Anesthesiology classification, intraoperative inotropic use, and operation complexity.
Tertiary general surgery service patients had a significantly increased risk of being reoperated on if the initial surgery was an emergency surgery compared with elective surgery. Unplanned reoperations led to a significantly increased mortality risk and a longer postoperative hospital stay, which could be regarded as warning signs in the care of surgical patients.
非计划性再次手术已被提议作为手术质量的指标，但尚未得到广泛研究，尤其是关于其危险因素。
这是一项三级普通外科服务中的前瞻性队列研究。收集了 2007 年 7 月至 2008 年 2 月间进行手术并在术后 30 天内进行随访的患者的数据。非计划性再次手术是主要终点。次要终点为 30 天死亡率和住院时间。多变量逻辑回归分析评估了这样一个假设，即在紧急情况下进行手术的患者再次手术的可能性更大，同时调整了相关协变量。
非计划性再次手术的累积发生率为 5.9%。在紧急情况下进行手术的患者再次手术的粗相对风险（RR）为 1.79（95%置信区间[CI]，1.15-2.78）。再次手术患者的死亡率 RR 为 8.94（95% CI，6.11-13.07）。未再次手术的患者的平均术后住院时间为 3 天，而再次手术的患者为 19 天（P=0.00001）。在调整年龄、性别、体重指数、美国麻醉医师协会分类、术中使用正性肌力药和手术复杂性后，急诊患者再次手术的逻辑回归模型的比值比（OR）为 2.83（95% CI，1.65-4.87）。
与择期手术相比，三级普通外科服务患者如果初始手术为急诊手术，再次手术的风险显著增加。非计划性再次手术导致死亡率显著增加和术后住院时间延长，这可被视为外科患者护理的警告信号。
