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[非计划重返手术室:医疗保健质量分析]

[Unplanned Return to the Operating Room: An analysis of the quality of the health care].

作者信息

Muranda Germán, Focacci Eduardo, Mena José, Montedonico Sandra

机构信息

Universidad de Valparaíso, Valparaíso, Chile.

Hospital Carlos Van Buren, Valparaíso, Chile.

出版信息

Rev Chil Pediatr. 2020 Dec;91(6):867-873. doi: 10.32641/rchped.vi91i6.1570. Epub 2020 Dec 1.

Abstract

INTRODUCTION

An Unplanned Return to the Operating Room (UROR) is an unplanned surgery performed during the first 30 days as a result of primary surgery. In Chile, the analysis and the UROR rate are quality indicators.

OBJECTIVE

to describe and analyze UROR in a pediatrics.

PATIENTS AND METHOD

Observa tional cross-sectional study. The clinical records of pediatric patients undergoing UROR at the Hos pital Carlos Van Buren over 5 years were reviewed. The incidence, indications, and causes of UROR were analyzed. The causes of UROR were classified as 1) causes attributable to surgical technique, 2) treatment-related causes, 3) the patient pathology, and 4) other causes. In addition, the observance of the case review meetings after an UROR was analyzed.

RESULTS

23 UROR out of 5,503 surgeries were performed in 5 years, (0.42%). There were 11 UROR out of 3,434 elective surgeries and 12 UROR out of 2,069 emergency ones (0.32% v/s 0.58% respectively, p=NS). There were 2 UROR out of 82 surgeries in newborns, (2.43%, p<0.01). After every UROR, a case review meeting was held. In 18 out of the 23 patients who underwent UROR (78%), the cause was attributable to the surgical technique or planning.

CONCLUSIONS

UROR is rare in pediatric surgery, except for the newborn period. Case review meetings are held after every UROR case, according to the national guidelines. The causes of UROR are mostly attributable to the surgical technique or planning.

摘要

引言

非计划重返手术室(UROR)是指在初次手术后30天内进行的非计划性手术。在智利,对UROR的分析及UROR发生率是质量指标。

目的

描述并分析儿科中的UROR情况。

患者与方法

观察性横断面研究。回顾了过去5年在卡洛斯·范布伦医院接受UROR的儿科患者的临床记录。分析了UROR的发生率、指征及原因。UROR的原因分为1)手术技术相关原因,2)治疗相关原因,3)患者病理原因,4)其他原因。此外,还分析了UROR后病例讨论会的召开情况。

结果

5年中5503例手术中有23例UROR(0.42%)。3434例择期手术中有11例UROR,2069例急诊手术中有12例UROR(分别为0.32%对0.58%,p=无统计学差异)。82例新生儿手术中有2例UROR(2.43%,p<0.01)。每次UROR后均召开了病例讨论会。23例接受UROR的患者中有18例(78%),其原因归因于手术技术或手术规划。

结论

UROR在儿科手术中很少见,新生儿期除外。根据国家指南,每次UROR病例后都会召开病例讨论会。UROR的原因大多归因于手术技术或手术规划。

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