Department of Colorectal Surgery, Cleveland Clinic, Cleveland, Ohio, USA.
Dis Colon Rectum. 2013 Feb;56(2):219-25. doi: 10.1097/DCR.0b013e3182765c43.
Accidental puncture or laceration during a surgical procedure is a patient safety indicator that is publicly reported and will factor into the Centers for Medicare and Medicaid's pay-for-performance plan. Accidental puncture or laceration includes serosal tear, enterotomy, and injury to the ureter, bladder, spleen, or blood vessels.
This study aimed to identify risk factors and assess surgical outcomes related to accidental puncture or laceration.
This is a retrospective study.
This study was conducted in a single-hospital department of colorectal surgery.
Inpatients undergoing colorectal surgery in which an accidental puncture or laceration did or did not occur were selected.
The primary outcomes measured were surgical complications, length of stay, and readmission.
Of 2897 operations, 269 had accidental puncture or laceration (9.2%) including serosal tear (47%), enterotomy (38%), and extraintestinal injuries (15%). Accidental puncture or laceration cases had more diagnoses of enterocutaneous fistula (11% vs 2%, p < 0.001), reoperative cases (91% vs 61%, p < 0.001), open surgery (96% vs 77%, p < 0.001), longer operative times (186 vs 146 minutes, p = 0.001), and increased length of stay (10 vs 7 days, p = 0.002). Patients with serosal tears had entirely similar outcomes to those without an injury, whereas patients with enterotomies had increased operative times and length of stay, and patients with extraintestinal injuries had higher rates of reoperation and sepsis (p < 0.05 for all).
This study was limited by the loss of sensitivity due to grouping extraintestinal injuries.
Accidental puncture or laceration is more likely to occur in complex colorectal operations. The clinical consequences range from none to significant depending on the specific type of injury. To make accidental puncture or laceration a more meaningful quality indicator, we advocate that groups who use the measure eliminate the injuries that have no bearing on surgical outcome and that risk adjustment for operative complexity is performed.
手术过程中的意外穿刺或撕裂是一个患者安全指标，会被公开报告，并将纳入医疗保险和医疗补助服务中心的绩效支付计划。意外穿刺或撕裂包括浆膜撕裂、肠切开术以及输尿管、膀胱、脾脏或血管损伤。
本研究旨在确定与意外穿刺或撕裂相关的危险因素，并评估手术结果。
这是一项回顾性研究。
本研究在一家单家医院的结直肠外科进行。
选择接受结直肠手术且发生或未发生意外穿刺或撕裂的住院患者。
主要观察指标为手术并发症、住院时间和再入院。
在 2897 例手术中，有 269 例发生意外穿刺或撕裂（9.2%），包括浆膜撕裂（47%）、肠切开术（38%）和肠外损伤（15%）。意外穿刺或撕裂病例中，肠外瘘（11%比 2%，p < 0.001）、再次手术（91%比 61%，p < 0.001）、开放性手术（96%比 77%，p < 0.001）、手术时间延长（186 比 146 分钟，p = 0.001）和住院时间延长（10 比 7 天，p = 0.002）的发生率更高。浆膜撕裂患者的结局与无损伤患者完全相同，而肠切开术患者的手术时间和住院时间延长，肠外损伤患者的再次手术和脓毒症发生率更高（p < 0.05）。
本研究因将肠外损伤分组而导致敏感性丧失。
意外穿刺或撕裂更可能发生在复杂的结直肠手术中。根据具体损伤类型，临床后果从无到显著不等。为了使意外穿刺或撕裂成为更有意义的质量指标，我们主张使用该指标的团体应消除与手术结果无关的损伤，并对手术复杂性进行风险调整。
