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[非白内障眼科门诊手术当日取消的发生率及原因分析]

[Analysis of the incidence and reasons of the same-day cancellation of non-cataract ophthalmic ambulatory surgery].

作者信息

Xi C H, Shi D J, Li Y H, Zhang Y, Yue J Y, Li M, Wang G Y

机构信息

Department of Anesthesiology, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China.

出版信息

Zhonghua Yi Xue Za Zhi. 2022 Jun 7;102(21):1608-1613. doi: 10.3760/cma.j.cn112137-20220212-00293.

Abstract

To investigate the incidence and reasons of the same-day cancellation of non-cataract ophthalmic ambulatory surgery, and to provide a basis for further improvement of the medical quality of ophthalmic ambulatory surgery. The data of the appointment for ophthalmic ambulatory surgeries from December 1, 2020 to November 30, 2021, including the patient's general condition, disease diagnosis, proposed surgical arrangement, anesthesia method and the completion of the surgeries, were collected through the electronic medical record management system in Beijing Tongren Hospital, Capital Medical University. The total number and incidence of cancelled surgeries registered in the surgical center were analyzed, the incidence of cancelled surgeries of different ages, sexes, subspecialty surgical types, anesthesia methods, patient sources were analyzed, and the reasons for surgical cancellation were further analyzed. A total of 10, 595 non-cataract ophthalmic day surgeries were applied, of which 827 were temporarily cancelled on the day of surgery, with a cancellation rate of 7.8%. The difference in the same-day surgery cancellation rate at different ages was statistically significant (<0.001), of which the surgery cancellation rate in toddler and infants was the lowest, which was 2.1% (23/1 110) and 3.4% (2/59), respectively, while the surgery cancellation rate was the highest in elderly patients over 75 years old, at 10.4% (48/462). There was a statistically significant difference in surgical cancellation rates among different sub-specialties (<0.001), with the lowest surgical cancellation rate in the tumor sub-specialty at 4.5% (33/732), while the corneal sub-specialty had the highest surgical cancellation rate at 14.3% (40/280), followed by the plastic sub-specialty with 11.8% (153/1 297). There were no statistically significant differences in the rate of surgical cancellation between different sexes, anesthesia methods or patients' home address (all >0.05). The most common reason for same-day surgery cancellation was the absence of the patient on the day of surgery (49.7%, 479/827), followed by changes in the patient's general condition (18.4%, 152/827), and inadequate preoperative preparation (6.0%, 50/827). 64.3% (532/827) of the same-day surgical cancellations were considered to have been avoided by enhancing preoperative communication, consultation and management. The same-day cancellation rate of ambulatory surgery in non-cataract ophthalmology is 7.8%, of which the cancellation rate in elderly patients and in less invasive surgery are higher. The absence of the patient on the same day and the change of the patient's condition are the main reasons for the cancellation of surgery on the same day, and most of them are avoidable.

摘要

调查非白内障眼科门诊手术当日取消的发生率及原因,为进一步提高眼科门诊手术医疗质量提供依据。通过首都医科大学附属北京同仁医院电子病历管理系统,收集2020年12月1日至2021年11月30日眼科门诊手术预约数据,包括患者一般情况、疾病诊断、拟手术安排、麻醉方式及手术完成情况。分析手术中心登记的取消手术总数及发生率,分析不同年龄、性别、亚专科手术类型、麻醉方式、患者来源的取消手术发生率,并进一步分析手术取消原因。共施行10595例非白内障眼科日间手术,其中827例于手术当日临时取消,取消率为7.8%。不同年龄组的当日手术取消率差异有统计学意义(<0.001),其中婴幼儿组手术取消率最低,分别为2.1%(23/1110)和3.4%(2/59),而75岁以上老年患者手术取消率最高,为10.4%(48/462)。不同亚专科的手术取消率差异有统计学意义(<0.001),肿瘤亚专科手术取消率最低,为4.5%(33/732),角膜亚专科手术取消率最高,为14.3%(40/280),其次是整形亚专科,为11.8%(153/1297)。不同性别、麻醉方式或患者家庭住址的手术取消率差异无统计学意义(均>0.05)。当日手术取消的最常见原因是患者手术当日未到场(49.7%,479/827),其次是患者一般情况变化(18.4%,152/827),以及术前准备不足(6.0%,50/827)。通过加强术前沟通、会诊及管理,64.3%(532/827)的当日手术取消可避免。非白内障眼科门诊手术当日取消率为7.8%,其中老年患者及微创手术取消率较高。患者当日未到场及病情变化是当日手术取消的主要原因,且大多可避免。

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