【摘要】 目的分析胃肠恶性肿瘤非计划再次手术原因、风险因素,构建风险预测模型。方法回顾性分析某三级甲等综合医院2015年1月1日-2019年12月31日出院的胃肠恶性肿瘤手术患者,筛选病例将2076例正常手术的病例作为对照组,23例非计划再次手术的病例作为研究组,分析研究组非计划再次手术的原因,对搜集的14项风险因素进行单因素分析,筛选出有统计学意义的指标进行Logistic回归并构建风险预测模型。结果胃肠恶性肿瘤非计划再次手术发生率为1.1%,主要原因为术后出血8例(34.78%)、切口问题4例(17.39%)、肠梗阻4例(17.39%)、造口并发症3例(13.04%),以上问题占比82.6%;经单因素分析诊断分类、是否抢救、是否造口、是否输血的组间比较差异有统计学意义;多因素Logistic回归分析得出输血(OR=4.766,P<0.001)与造口(OR=3.093,P<0.05)为非计划再次手术的独立危险因素,风险模型检验具有统计学意义,x~2=19.177,P<0.001,经Hosmer-Lemeshow检验提示模型拟合较好,x~2=0.274,P>0.05。结论非计划再次手术增加患者住院天数、增加患者经济负担,应关注输血及造口患者,提高医务人员医疗技术水平,减少术后出血、切口感染、肠梗阻及造口并发症的发生。更多还原

【Abstract】 Objectives To analyze the causes, the risk factors of unplanned reoperation for gastrointestinal cancer and to establish a risk prediction model. Methods A retrospective analysis was performed on patients undergoing surgery for gastrointestinal malignant tumor who were discharged from a Three A and Tertiary General Hospital from January 1st, 2015 to December 31st, 2019. Through case screening, 2076 patients undergoing normal surgery were selected as the control group, and 23 patients undergoing unplanned re-operation were selected as the study group, and the reasons for unplanned re-operation in the study group were analyzed. The 14 risk factors collected were analyzed by univariate analysis, and statistically significant indicators were screened out for Logistic regression and a risk prediction model was established. Results The incidence rate of unplanned reoperation was 1.1%, the main causes were postoperative bleeding in 8 cases(34.78%), incision problems in 4 cases(17.39%), postoperative obstruction in 4 cases(17.39%), stoma problems in 3 cases(13.04%), single-factor showed that there was significant difference between the groups of diagnosis and classification, rescue, stoma and blood transfusion and multiple-factor logistic regression analysis showed that blood transfusion(OR=4.766,P<0.001) and stoma(OR=3.093,P<0.05) were independent risk factors for unplanned reoperation. The risk model test was statistically significant(x~2= 19.177, P<0.001), it was suggested that the model fitted well(x~2=0.274, P>0.05). Conclusions Unplanned reoperation could increase the length of hospital stay and increase the financial burden of patients. Attention should be paid to blood transfusion and stoma patients to improve the medical skill level of medical staff, to reduce postoperative bleeding, wound infection, intestinal obstruction and stoma complications.更多还原