背景:门诊手术中心(ASC)手术后的计划外入院是衡量护理质量的既定指标,可能会影响患者的体验。以前关于这个主题的研究通常是过时的,专注于一个专业,或研究门诊手术后30天入院。很少有研究报道ASC手术后24小时内入院,这是麻醉和手术护理质量的不同但重要的衡量标准。了解手术后24小时内的入院可以在手术后立即确定改善的机会。因此,我们的研究旨在评估在医院ASC进行手术后24小时内计划外住院的发生率和危险因素.
方法:机构审查委员会批准后,我们对2016年1月1日至2022年12月31日期间在美国ASC接受手术的所有成年患者进行了回顾性分析.数据来自医院的电子病历。研究样本分为两组:手术后24小时内计划外住院的人和没有计划外住院的人。评估计划外住院的危险因素,p值<0.05的单变量分析用于确定与入院相关的显著患者变量.使用多变量Firth逻辑回归进一步调整这些变量。使用描述性统计来探索不同变量类别中的患者数量。
结果:总体而言,在7年期间确定了53,185例。在此期间,计划外住院的发生率为0.09%(95%CI0.07-0.122%;每年范围为0.05-0.12%。在多变量模型中,手术时间(OR1.010,95%CI1.007-1.012,p值<0.0001),外周血管疾病(OR14.489,95%CI4.862-43.174,p值<0.0001),深静脉血栓形成(OR5.527,95%CI1.909-16.001,p值=0.0016)与计划外入院显著相关.
结论:大型三级护理门诊手术中心手术后计划外入院的总发生率非常低。这个入学率也可以作为未来研究和质量改进计划的参考点。
BACKGROUND: Unplanned admission after surgery at an
ambulatory surgery center (ASC) is an established measure of the quality of care and can affect the patient\'s experience. Previous studies on this topic are generally dated, focused on a single specialty, or studied 30-day admissions after
ambulatory surgery. Few studies have reported admission within 24 h after surgery at an ASC which is a different but important measure of the quality of anesthetic and surgical care. Understanding admissions within 24 h of surgery can identify opportunities for improvement immediately after surgery. Therefore, our study was designed to assess the incidence and risk factors for unplanned hospital admissions within 24 h after surgery performed at a hospital ASC.
METHODS: After Institutional Review Board approval, a retrospective analysis was performed on all adult patients who underwent surgery at a US ASC between January 1, 2016, and December 31, 2022. Data were obtained from the hospital\'s electronic medical record. The study sample was divided into two groups: those with an unplanned hospital admission within 24 h after surgery and those without an unplanned hospital admission. To evaluate risk factors for unplanned hospital admissions, univariate analyses with p value < 0.05 were utilized to identify significant patient variables related to hospital admissions. These variables were further adjusted using a multivariable Firth logistic regression. Descriptive statistics were used to explore the number of patients in different variable categories.
RESULTS: Overall, 53,185 cases were identified for the 7-year period. The incidence of unplanned hospital admission over this period was 0.09% (95% CI 0.07-0.1122%; ranging from 0.05 to 0.12% per year. In the multivariable model, surgery duration (OR 1.010, 95% CI 1.007-1.012, p value < 0.0001), peripheral vascular disease (OR 14.489, 95% CI 4.862-43.174, p value < 0.0001), and deep venous thrombosis (OR 5.527, 95% CI 1.909-16.001, p value = 0.0016) were significantly associated with unplanned hospital admission.
CONCLUSIONS: The overall incidence of unplanned hospital admission after surgery at a large tertiary care
ambulatory surgery center is very low. This admission rate can also serve as a reference point for future studies and quality improvement initiatives.