School of Computing and Information Technology, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, New South Wales, Australia; Department of Information and Communication Technology, Faculty of Technology, Rajarata University of Sri Lanka, Mihintale, Sri Lanka.
School of Computing and Information Technology, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, New South Wales, Australia; Graduate School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia.
Surgery. 2024 Oct;176(4):1001-1007. doi: 10.1016/j.surg.2024.06.048. Epub 2024 Jul 25.
This study aims to identify the common pathways of appendicectomy, the most common emergency surgery in Australia's public hospitals and any variations within a regional public health district in New South Wales, Australia.
We analyzed the electronic medical records of 3,943 patients who underwent appendicectomy between January 2014 and July 2020 at 2 hospitals in the Illawarra Shoalhaven Local Health District, New South Wales, Australia, using the PM approach for surgical pathway identification and subsequent statistical analyses.
Among 3,943 patients, 3,606 (91.5%) followed an 11-step main pathway: (1) emergency department admission, (2) surgery booking, (3) anesthesia start, (4) operating room entry, (5) surgery start, (6) surgery end, (7) anesthesia end, (8) operating room discharge, (9) postanesthesia care unit admission, (10) postanesthesia care unit discharge, and (11) hospital discharge. The median length of stay was 48.13 hours (interquartile range 32.74). The main pathway differed from either variation 1 (n = 246, 6.2%) or variation 2 (n = 30, 0.8%) only in the timing and location of anesthesia administration or conclusion. Variation 3 (n = 26, 0.7%) included patients who underwent appendicectomy twice, whereas variation 4 (n = 25, 0.6%) included patients booked for surgery before emergency department admission through community doctor referrals. Thirteen exceptional cases experienced combinations of the aforementioned pathways. The length of stay and phase durations varied between the main pathway and these variations.
The appendicectomy pathway was largely standardized across the studied hospitals, with the location of anesthesia administration or conclusion affecting specific stages but not the overall length of stay. Only a complex 2-surgery pathway increased length of stay.
本研究旨在确定在澳大利亚公立医院最常见的紧急手术——阑尾切除术的常见途径，以及在澳大利亚新南威尔士州伊拉瓦拉肖尔黑文地区卫生区的任何差异。
我们使用 PM 方法对 2014 年 1 月至 2020 年 7 月在新南威尔士州伊拉瓦拉肖尔黑文地区卫生区的 2 家医院接受阑尾切除术的 3943 名患者的电子病历进行了分析，用于手术途径识别和随后的统计分析。
在 3943 名患者中，有 3606 名（91.5%）遵循 11 步主要途径：（1）急诊部入院，（2）手术预约，（3）麻醉开始，（4）进入手术室，（5）手术开始，（6）手术结束，（7）麻醉结束，（8）离开手术室，（9）麻醉后护理单元入院，（10）麻醉后护理单元出院，（11）出院。中位住院时间为 48.13 小时（四分位间距 32.74）。主要途径仅在麻醉管理或结束的时间和地点上与变异 1（n=246，6.2%）或变异 2（n=30，0.8%）不同。变异 3（n=26，0.7%）包括两次接受阑尾切除术的患者，而变异 4（n=25，0.6%）包括通过社区医生转介在急诊部入院前预约手术的患者。13 例特殊病例经历了上述途径的组合。主要途径和这些变异之间的住院时间和阶段持续时间有所不同。
在研究的医院中，阑尾切除术途径在很大程度上是标准化的，麻醉管理或结束的位置影响特定阶段，但不影响总住院时间。只有复杂的 2 次手术途径会增加住院时间。
