非工作日手术对患者住院期间死亡及重要器官功能衰竭的影响
The effect of non-working day surgery on in-hospital mortality and postoperative vital organ failure
刘潜 1匡姝瑜 2周莉 1刘进1
作者信息
- 1. 四川大学华西医院麻醉科,四川成都 610041
- 2. 四川大学华西临床医学院,四川成都 610041
- 折叠
摘要
目的 探究非工作日手术对患者住院期间死亡及术后重要器官功能衰竭的影响.方法 收集2021年华西医院住院时间≥24 h、住院期间接受手术患者病例资料.根据手术结束时间将患者分为两组:工作日组和非工作日组(包括法定节假日).采取倾向得分匹配法比较两组患者住院期间死亡率、术后重要器官功能衰竭发生率等方面的差异.结果 研究共纳入74 664例病例,其中工作日组64 433例,非工作日组10 201例.匹配前,纳入全部可干预及不可干预因素的二元logistics回归分析显示,非工作日手术是影响患者住院期间死亡率及术后重要器官功能衰竭发生率的独立危险因素(OR=1.16,95％CI:1.00～1.35,P=0.04;OR=1.23,95％CI:1.07～1.42,P＜0.01).此外,是否为微创手术及出血量也是影响住院期间死亡率及术后重要器官功能衰竭的独立危险因素(P＜0.05).匹配后,非工作日组住院期间死亡率(2.6％vs 1.7％)与术后重要器官功能衰竭发生率(3.5％vs 2.3％)显著高于工作日组(P＜0.01);同时,非工作日手术的手术时间(1.5 h vs 1.3 h)、出血量超过500 ml患者比例(2.5％vs 1.9％)亦高于工作日组(P＜0.05),采用微创术式的手术比例(58.6％vs 60.6％)低于工作日组.结论 非工作日手术患者术后死亡率、术后重要器官功能衰竭率更高.若减少非工作日手术时长与术中出血量,增加微创手术比例,可能会降低非工作日手术患者住院期间死亡率及术后重要器官衰竭发生率.
Abstract
Objective To investigate the effect of non-working day surgery on mortality and postoperative vital or-gan failure during hospitalization.Methods In 2021,the case data of patients who had a hospitalization time over 24 hours and underwent surgery during hospitalization in West China Hospital were collected.Patients were divided into two groups according to the day of the operation:working day group and non-working day group(including statutory holidays).Propensity score matching analysis was used to compare the differences in mortality and incidence of postop-erative vital organ failure between the two groups.Results The study included 74 664 cases,of which 64 433 cases were in the working day group and 10 201 cases were in the non-working day group.Before matching,binary logistic re-gression analysis of all Intervenable and non-Intervenable factors showed that non-workday surgery was an independent risk factor for mortality and postoperative organ failure(OR=1.16,95％CI:1.00～1.35,P=0.04;OR=1.23,95％CI:1.07～1.42,P＜0.01).Furthermore,minimally invasive surgery and blood loss were also independent risk factors for mortality and postoperative vital organ failure(P＜0.05).After matching,the mortality rate(2.6％vs 1.7％)and the incidence of postoperative organ failure(3.5％vs 2.3％)in the non-working day group were significantly higher than those in the working day group(P＜0.01).Meanwhile,the operation time(1.5h vs 1.3h)and the proportion of patients with blood loss more than 500 ml(2.5％vs 1.9％)in the non-workday group were higher than those in the workday group(P＜0.05),and the proportion of minimally invasive surgery(58.6％vs 60.6％)was lower than that in the working day group.Conclusion The in-hospital mortality and the rate of postoperative vital organ failure of patients who underwent surgeries on non-working days were higher than working days.By reducing length of surgery and intra-operative blood loss on non-working days and increasing the proportion of minimally invasive surgery,it may be possible to reduce the in-hospital mortality rate and the incidence of postoperative vital organ failure in patients undergoing sur-geries on non-working days.
关键词
回顾性研究/非工作日手术/周末效应/住院期间死亡/术后重要器官功能衰竭Key words
retrospective studies/non-working day surgery/weekend effect/in-hospital mortality/postoperative vital organ failure引用本文复制引用
基金项目
四川省中央引导地方科技发展专项科技创新基地建设项目(2023ZYD0168)
出版年
2024
NETL
NSTL
万方数据