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Role of Establishing General Surgery Emergency Surgical Team in Improving the Work Efficiency of Emergency Surgery
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摘要:
目的 探讨成立基本外科急诊手术团队在提高急诊外科诊疗效率中的作用。 方法 回顾性收集2019年8月1日—2021年7月31日北京协和医院基本外科急诊手术团队接诊的所有患者临床资料。比较基本外科急诊手术团队成立前后流水量、留观量及留观患者比例。分析基本外科急诊手术患者的临床资料(年龄、性别、合并症、诊断结果、手术量、病情分级、术前准备时间、术后转入ICU病房的比例、住院时间＞30 d的患者比例、并发症发生率), 并按手术级别和病情分级比较住院时间与住院费用。采用多元线性回归法分析患者住院费用的影响因素。 结果 共纳入37 945例于急诊外科就诊的流水患者。急诊手术团队成立前后的流水患者总数分别为15 745例、22 200例(平均每月分别为1312例、1850例), 留观患者总数分别为1814例、1622例(平均每月分别为151例、135例)。急诊手术团队成立后, 留观患者比例由11.6%下降至7.3%(P=0.000), 术前准备时间显著缩短[(0.7±0.9)d比(1.5±0.7)d, P=0.000], 术后转入ICU病房的患者比例(23.7%比37.9%, P=0.000)、住院时间＞30 d的患者比例(0.5%比5.7%, P=0.000)均下降, 中位住院时间(3 d比5 d, P=0.028)与中位住院费用(1.3万比3.4万, P=0.000)均明显减少, 平均手术量增加(77例比26例, P=0.000), 并发症发生率(6.0%比5.1%, P=0.548)无明显变化。多元线性回归分析结果显示, 成立基本外科急诊手术团队是降低住院费用的独立影响因素, 病情危重、住院时间长、术后转入ICU病房是增加住院费用的独立影响因素。 结论 成立基本外科急诊手术团队可在一定程度上缓解急诊压力, 如减轻急诊拥堵程度、提高急诊手术周转率、减轻患者医疗负担等, 提高诊疗效率。 Abstract:Objective To explore the role of establishing general surgical emergency team in improving the efficiency of emergency surgical treatment. Methods All patients attending emergency surgery from August1, 2019 to July 31, 2021 were retrospectively analysed. The number of flow, observation and their ratio before and after the establishment of general surgical emergency team were compared. The clinical data, including age, gender, complication, diagnoses, the number of surgery, the grading of disease, preoperative preparation time, the ratio of transfer to ICU, the ratio of patients staying more than 30 days, and complication rate before and after the establishment were analysed. Length of stay and hospitalization costs were compared by surgical grading and disease severity grading. The factors affecting hospitalization costs in emergency surgery patients were analysed using univariate and multiple linear regression. Results A total of 37 945 flow patients were included. Before and after the establishment of the surgical team, the number of flow was 15 745 and 22 200, respectively (1312 and 1850 monthly), the number of observation was 1814 and 1622, respectively (151 and 135 monthly), and the ratio of observation to flow decreased from 11.6% to 7.3% (P=0.000), preoperative preparation time decreased from (1.5±0.7) days to (0.7±0.9) days (P=0.000), the ratio of transfer to ICU decreased from 37.9% to 23.7% (P=0.000), the ratio of patients staying more than 30 days decreased from 5.7% to 0.5% (P=0.000), the average length of stay (5 d vs. 3 d, P=0.028) and cost (34 000 vs. 13 000, P=0.000) were significantly reduced, and the total operation number were 317 and 919, respectively(26 vs. 77 monthly, P=0.000).There was no significant change in complication rate (P=0.548). Multiple linear regression showed that establishing emergency surgery team reduced the hospitalization cost, while high surgical grading, long hospitalization time and transfer to ICU increased the hospitalization cost. Conclusion The establishment of emergency surgery team can solve the current problem of emergency to some degree, such as evacuating emergency congestion, increasing emergency surgery turnover rate, reducing the medical burden, and improving the efficiency of emergency treatment. -
Key words:
- general surgery /
- emergency surgery /
- emergency congestion /
- length of stay /
- hospitalization costs /
作者贡献：岳强、马小睦负责设计实施、数据收集与分析、论文撰写；陈伟杰负责研究设计与指导；叶欣、张冠南、陆君阳、韩显林、王维斌负责研究实施；张太平、翁习生负责提供技术支持和指导。利益冲突：所有作者均声明不存在利益冲突 -
表 1 基本外科急诊手术团队成立前后接诊患者一般资料比较
项目 急诊手术团队成立前(n=15 745) 急诊手术团队成立后(n=22 200) 年龄(x±s，岁) 58.4±12.2 54.6±16.2 男性患者比例(%) 54.5 47.6 合并基础疾病患者比例(%) 48 42 留观患者比例(%) 11.6 7.3 平均手术量(n) 26 77 
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表 2 基本外科急诊手术团队成立前后急诊手术患者住院费用单因素分析
指标 例数(%) 中位住院费用(万元) P值 性别 男 579(46.8) 2.9 0.560 女 657(53.2) 3.0 年龄(岁) ＜45 190(15.4) 2.9 0.644 45~60 428(34.6) 2.9 61~75 452(36.6) 3.0 ＞75 166(13.4) 3.0 住院时间(d) ＜3 634(51.3) 1.1 0.000 3~6 256(20.7) 2.5 ＞6 346(28.0) 6.8 术后转入ICU病房 否 898(72.7) 1.8 0.000 是 338(27.3) 6.0 手术分级 1 31(2.5) 1.3 0.000 2 72(5.8) 2.0 3 1028(83.2) 2.4 4 105(8.5) 5.7 成立急诊手术团队 否 317(25.7) 5.5 0.000 是 919(74.3) 2.5 病情分级 1级 32(2.6) 6.2 0.000 2级 620(50.2) 4.1 3级 584(47.2) 2.4
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表 3 基本外科急诊手术患者住院费用影响因素的多元线性回归分析结果
指标 非标准化系数 标准化系数β t值 P值 95% CI 共线性 β 标准误 容差值 VIF 常量 5.225 0.121 43.154 0.000 4.988~5.463 住院时间＜3 d 0.143 0.008 0.316 17.674 0.000 0.127~0.158 0.449 2.228 术后转入ICU病房 0.139 0.013 0.163 10.508 0.000 0.113~0.164 0.595 1.680 成立急诊手术团队 -0.041 0.012 -0.046 -3.569 0.000 -0.064~-0.019 0.857 1.167 病情分级1级 -0.476 0.022 -0.612 -22.049 0.000 -0.518~-0.433 0.186 5.368 病情分级2级 -0.066 0.022 -0.078 -2.941 0.003 -0.110~-0.022 0.203 4.925 VIF：方差膨胀因子；F=1483.320，P＜0.001，R2=0.860
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