Ifesanya Adeleke O, Ogundele Olumuyiwa J, Ifesanya Joy U
Department of Orthopaedics and Trauma, University College Hospital, Ibadan, Nigeria.
Department of Child Oral Health, University College Hospital, Ibadan, Nigeria.
Niger Med J. 2013 Nov;54(6):420-5. doi: 10.4103/0300-1652.126301.
Delay in surgical treatment is a source of distress to patients and an important reason for poor outcome. We studied the delay before carrying out scheduled operative orthopaedic procedures and the factors responsible for it.
This prospective study was carried out between March 2011 and December 2012. Temporal details of the surgical procedures at our hospital were recorded in a proforma including the patients' perception of the causes of the delay to surgery. Based on the urgency of the need for surgery, patients were classified into three groups using a modification of the method employed by Lankester et al. Data was analyzed using the Statistical Package for the Social Sciences, version 17.0. Predictors of surgical delay beyond 3 days were identified by logistic regression analysis.
Two hundred and forty-nine patients with a mean age 36.2 ± 19.2 years and M:F ratio 1.3 were recruited. 34.1% were modified Lankester group A, 45.4% group B and 20.5% group C. 47 patients (18.9%) had comorbidities, hypertension being the commonest (22 patients; 8.8%). Median delay to surgery was 4 days (mean = 17.6 days). Fifty percent of emergency room admissions were operated on within 3 days, the figure was 13% for other admissions. Lack of theatre slot was the commonest cause of delay. There was full concordance between doctors and patients in only 70.7% regarding the causes of the delay. In 15.7%, there was complete discordance. Logistic regression analysis confirmed modified Lankester groups B and C (P = 0.003) and weekend admission (P = 0.016) as significant predictors of delay to surgery of >3 days.
Promptness to operative surgical care falls short of the ideal. Theatre inefficiency is a major cause of delay in treating surgical patients in our environment. Theatre facilities should be expanded and made more efficient. There is a need for better communication between surgeons and patients about delays in surgical treatment.
手术治疗延迟是患者痛苦的来源，也是预后不良的重要原因。我们研究了在进行预定的骨科手术前的延迟情况及其相关因素。
这项前瞻性研究于2011年3月至2012年12月进行。我们医院手术程序的时间细节记录在一份表格中，包括患者对手术延迟原因的看法。根据手术需求的紧迫性，采用对Lankester等人所使用方法的改良，将患者分为三组。使用社会科学统计软件包第17.0版进行数据分析。通过逻辑回归分析确定手术延迟超过3天的预测因素。
招募了249名患者，平均年龄36.2±19.2岁，男女性别比为1.3。34.1%为改良Lankester A组，45.4%为B组，20.5%为C组。47名患者（18.9%）有合并症，高血压最为常见（22名患者；8.8%）。手术的中位延迟时间为4天（平均=17.6天）。50%的急诊室入院患者在3天内接受手术，其他入院患者的这一比例为13%。手术室时间安排不足是延迟的最常见原因。在延迟原因方面，医生和患者之间只有70.7%完全一致。在15.7%的情况下，完全不一致。逻辑回归分析证实改良Lankester B组和C组（P = 0.003）以及周末入院（P = 0.016）是手术延迟超过3天的显著预测因素。
手术治疗的及时性未达到理想状态。手术室效率低下是我们环境中手术患者治疗延迟的主要原因。应扩大手术室设施并提高其效率。外科医生和患者之间需要就手术治疗延迟进行更好的沟通。
