与择期手术推迟相关的非医学风险因素：一项前瞻性观察研究。
Non-medical risk factors associated with postponing elective surgery: a prospective observational study.
机构信息
Department of Anesthesiology and Intensive Care Medicine, University Hospital of Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany.
Operating Room Management, University Hospital of Leipzig, Leipzig, Germany.
出版信息
BMC Med Ethics. 2021 Jul 13;22(1):90. doi: 10.1186/s12910-021-00660-0.
BACKGROUND
Operation room (OR) planning is a complex process, especially in large hospitals with high rates of unplanned emergency procedures. Postponing elective surgery in order to provide capacity for emergency operations is inevitable at times. Elderly patients, residents of nursing homes, women, patients with low socioeconomic status and ethnic minorities are at risk for undertreatment in other contexts, as suggested by reports in the medical literature. We hypothesized that specific patient groups could be at higher risk for having their elective surgery rescheduled for non-medical reasons.
METHODS
In this single center, prospective observational trial, we analysed 2519 patients undergoing elective surgery from October 2018 to May 2019. A 14-item questionnaire was handed out to illicit patient details. Additional characteristics were collected using electronic patient records. Information on the timely performance of the scheduled surgery was obtained using the OR's patient data management system. 6.45% of all planned procedures analysed were postponed. Association of specific variables with postponement rates were analysed using the Mann-Whitney U test and Fisher's exact test/χ-test.
RESULTS
Significantly higher rates of postponing elective surgery were found in elderly patients. No significant differences in postponing rates were found for the variables gender, nationality (Germany, EU, non-EU), native language, professional medical background and level of education. Significantly lower rescheduling rates were found in patients with ties to hospital staff and in patients with a private health insurer.
CONCLUSIONS
Elderly patients, retirees and nursing home residents seem to be at higher risk for having their elective surgery rescheduled. However, owing to the study design, causality could not be proven. Our findings raise concern about possible undertreatment of these patient groups and provide data on short-term postponement of elective surgery. Trial registration DRKS00015836. Retrospectively registered.
背景
手术室（OR）规划是一个复杂的过程，尤其是在高比例非计划性急诊手术的大医院。为了为急诊手术提供容量，有时不可避免地需要推迟择期手术。老年人、养老院居民、女性、社会经济地位较低的患者和少数民族在其他情况下存在治疗不足的风险，这一点在医学文献中有报道。我们假设特定的患者群体可能因非医疗原因而更有可能将其择期手术重新安排。
方法
在这项单中心、前瞻性观察性试验中，我们分析了 2018 年 10 月至 2019 年 5 月期间接受择期手术的 2519 名患者。我们向患者发放了一份包含 14 个问题的问卷，以获取患者详细信息。使用电子病历收集了其他特征。使用手术室的患者数据管理系统获取了关于按时进行计划手术的信息。分析的所有计划手术中有 6.45%被推迟。使用曼-惠特尼 U 检验和 Fisher 确切检验/χ 检验分析特定变量与推迟率的关联。
结果
发现老年患者择期手术的推迟率显著更高。在性别、国籍（德国、欧盟、非欧盟）、母语、专业医疗背景和教育程度等变量方面，推迟率没有显著差异。与医院工作人员有联系的患者和有私人医疗保险的患者的重新安排率明显较低。
结论
老年患者、退休人员和养老院居民似乎更有可能将其择期手术重新安排。然而，由于研究设计，不能证明因果关系。我们的研究结果表明，这些患者群体可能存在治疗不足的情况，并提供了择期手术短期推迟的数据。试验注册 DRKS00015836。回顾性注册。
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