非工作时间的择期手术重症监护病房入院情况及其相关并发症。

Out-of-office hours' elective surgical intensive care admissions and their associated complications.

作者信息

Morgan David J R, Ho Kwok Ming, Ong Yang Jian, Kolybaba Marlene L

机构信息

Department of Intensive Care Medicine, St John of God Subiaco Hospital, Perth, Western Australia, Australia.

School of Population Health, The University of Western Australia, Perth, Western Australia, Australia.

出版信息

ANZ J Surg. 2017 Nov;87(11):886-892. doi: 10.1111/ans.14027. Epub 2017 Jun 12.

DOI:10.1111/ans.14027

PMID:28608513

Abstract

BACKGROUND

The 'weekend' effect is a controversial theory that links reduced staffing levels, staffing seniority and supportive services at hospitals during 'out-of-office hours' time periods with worsening patient outcomes. It is uncertain whether admitting elective surgery patients to intensive care units (ICU) during 'out-of-office hours' time periods mitigates this affect through higher staffing ratios and seniority.

METHODS

Over a 3-year period in Western Australia's largest private hospital, this retrospective nested-cohort study compared all elective surgical patients admitted to the ICU based on whether their admission occurred 'in-office hours' (Monday-Friday 08.00-18.00 hours) or 'out-of-office hours' (all other times). The main outcomes were surgical complications using the Dindo-Clavien classification and length-of-stay data.

RESULTS

Of the total 4363 ICU admissions, 3584 ICU admissions were planned following elective surgery resulting in 2515 (70.2%) in-office hours and 1069 (29.8%) out-of-office hours elective ICU surgical admissions. Out-of-office hours ICU admissions following elective surgery were associated with an increased risk of infection (P = 0.029), blood transfusion (P = 0.020), total parental nutrition (P < 0.001) and unplanned re-operations (P = 0.027). Out-of-office hours ICU admissions were also associated with an increased hospital length-of-stay, with (1.74 days longer, P < 0.0001) and without (2.8 days longer, P < 0.001) adjusting for severity of acute and chronic illnesses and inter-hospital transfers (12.3 versus 9.8%, P = 0.024). Hospital mortality (1.2 versus 0.7%, P = 0.111) was low and similar between both groups.

CONCLUSION

Out-of-office hours ICU admissions following elective surgery is common and associated with serious post-operative complications culminating in significantly longer hospital length-of-stays and greater transfers with important patient and health economic implications.

摘要

背景

“周末”效应是一种存在争议的理论，该理论将医院在“非工作时间”的人员配备水平降低、人员资历以及支持性服务与患者预后恶化联系起来。在“非工作时间”将择期手术患者收入重症监护病房（ICU）是否能通过更高的人员配备比例和资历减轻这种影响尚不确定。

方法

在西澳大利亚最大的私立医院进行的一项为期3年的回顾性巢式队列研究中，比较了所有因择期手术收入ICU的患者，根据其收入时间是“工作时间”（周一至周五08:00 - 18:00）还是“非工作时间”（其他所有时间）。主要结局指标是采用Dindo-Clavien分类法的手术并发症以及住院时间数据。

结果

在总共4363例ICU收入病例中，3584例是择期手术后计划收入ICU的，其中2515例（70.2%）在工作时间，1069例（29.8%）在非工作时间进行择期ICU手术收入。择期手术后在非工作时间收入ICU与感染风险增加（P = 0.029）、输血风险增加（P = 0.020）、全胃肠外营养风险增加（P < 0.001）以及非计划再次手术风险增加（P = 0.027）相关。在非工作时间收入ICU还与住院时间延长相关，在调整急慢性疾病严重程度和医院间转院情况后（长1.74天，P < 0.0001）以及未调整时（长2.8天，P < 0.001）（转院率分别为12.3%和9.8%，P = 0.024）。两组的医院死亡率均较低且相似（分别为1.2%和0.7%，P = 0.111）。