李晔;翁习生;沈建雄;仉建国;赵宏;赵宇;田野;胡建华;李书纲;于斌;王以朋;
LI Ye;WENG Xi-sheng;SHEN Jian-xiong;ZHANG Jian-guo;ZHAO Hong;ZHAO Yu;TIAN Ye;HU Jian-hua;LI Shu-gang;YU Bin;WANG Yi-peng;Department of Orthopedics,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences & Peking Union Medical College;

• 1:中国医学科学院 北京协和医学院 北京协和医院骨科

摘要(Abstract)：

目的分析脊柱外科非计划再次手术的原因,为提高脊柱外科医疗服务质量提供客观依据。方法回顾性分析本院2012年2月至2013年7月脊柱外科住院行非计划再次手术患者的临床资料,对造成非计划再次手术的原因、患者术后转归、平均住院日和住院患者满意度进行分析。结果共22例脊柱外科患者行非计划再次手术,其中8例患者手术原因为螺钉位置欠佳,6例患者发生伤口愈合不良,7例患者出现术后肢体感觉和力量异常。通过调整螺钉位置、伤口清创和椎管探查、减压等手术方式可使患者获得相对较好的预后,但所涉及患者的平均住院日较同期未发生非计划再次手术的脊柱外科患者延长(25.6 d比12.5 d),住院患者满意度降低(85.2分比97.7分)。结论加强对非计划再次手术的监管非常重要。对单个学科非计划再次手术原因进行分析并提出预防措施,有利于提高该学科整体诊疗水平。
Objective To investigate the causes of unplanned reoperations of spinal surgery. Methods Patients hospitalized in the department of spinal surgery who underwent unplanned reoperations from February 2012 to July 2013 were retrospectively analyzed. The potential causes of unplanned reoperations were summarized. The postoperative outcome,average duration of hospital stay and satisfaction of these inpatients were also analyzed. Results A total of 22 patients underwent unplanned reoperations in the department of spinal surgery. Among these 22 patients,unplanned reoperations were performed due to unsatisfied pedicle screw placement in 8 cases,incision problems in 6 cases,and abnormal sensation or muscle strength in 7 cases. Adjustment of screw location,wound debridement,and spinal canal exploration / decompression yielded good outcomes. However,the average duration of hospital stay of these patients was longer than those without unplanned reoperations( 25. 6 d vs 12. 5 d) and the average inpatient satisfaction was lower( 85. 2 vs 97. 7). Conclusions Monitoring of unplanned reoperations is particularly important. The specific causes of unplanned reoperations in different departments should be carefully analyzed to inform the improvements.

关键词(KeyWords)： 脊柱外科;非计划再次手术
spinal surgery;unplanned reoperation

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 李晔;翁习生;沈建雄;仉建国;赵宏;赵宇;田野;胡建华;李书纲;于斌;王以朋;
LI Ye;WENG Xi-sheng;SHEN Jian-xiong;ZHANG Jian-guo;ZHAO Hong;ZHAO Yu;TIAN Ye;HU Jian-hua;LI Shu-gang;YU Bin;WANG Yi-peng;Department of Orthopedics,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences & Peking Union Medical College;

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参考文献(References)：

• [1]周谦,王婉娜,谢雪,等.某医院非计划再手术原因分析[J].中国病案,2012,13:52-53.
• [2]朱志峰,邵琳,赵越.北京市某医院非计划再手术原因分析[J].中国医院管理,2012,32:17-19.
• [3]陆叶珍,余华,杨燕,等.关于加强非计划再次手术监管的探讨[J].中国医院管理,2012,32:32-33.
• [4]Isbister WH.Unplanned return to the operating room[J].Aust NZ J Surg,1998,68:143-146.
• [5]Birkmeyer JD,Hamby LS,Birkmeyer CM,et al.Is unplanned return to the operating room a useful quality indicator in general surgery?[J].Arch Surg,2001,136:405-411.
• [6]Brown C,Hofer T,Johal A,et al.An epistemology of patient safety research:a framework for study design and interpretation[J].Qual Saf Health Care,2008,17:158-181.
• [7]Auerbach JD,Lenke LG,Bridwell KH,et al.Major complications and comparison between 3-column osteotomy techniques in 105 consecutive spinal deformity procedures[J].Spine(Phila Pa 1976),2012,37:1198-1210.
• [8]Martin BI,Mirza SK,Comstock BA,et al.Reoperation rates following lumbar spine surgery and the influence of spinal fusion procedures[J].Spine(Phila Pa 1976),2007,32:382-387.
• [9]Mok JM,Cloyd JM,Bradford DS,et al.Reoperation after primary fusion for adult spinal deformity:rate,reason,and timing[J].Spine(Phila Pa 1976),2009,34:832-839.
• [10]Belmont PJ Jr,Klemme WR,Robinson M,et al.Accuracy of thoracic pedicle screws in patients with and without coronal plane spinal deformities[J].Spine(Phila Pa 1976),2002,27:1558-1566.
• [11]Kim YJ,Lenke LG,Bridwell KH,et al.Free hand pedicle screw placement in the thoracic spine:is it safe?[J].Spine(Phila Pa 1976),2004,29:333-342.
• [12]Samdani AF,Ranade A,Sciubba DM,et al.Accuracy of free-hand placement of thoracic pedicle screws in adolescent idiopathic scoliosis:how much of a difference does surgeon experience make?[J].Eur Spine J,2010,19:91-95.
• [13]Olsen MA,Mayfield J,Lauryssen C,et al.Risk factors for surgical site infection in spinal surgery[J].J Neurosurg,2003,98:149-155.
• [14]Massie JB,Heller JG,Abitbol JJ,et al.Postoperative posterior spinal wound infections[J].Clin Orthop Relat Res,1992,284:99-108.
• [15]Fang A,Hu SS,Endres N,et al.Risk factors for infection after spinal surgery[J].Spine(Phila Pa 1976),2005,30:1460-1465.