肿瘤专科医院胸外科住院日超过30天影响因素分析

摘要

目的：分析肿瘤专科医院胸外科住院患者资料，明确住院日超过30天的主要原因并分析影响因素。方法收集胸外科12423例出院患者住院信息，其中396例患者住院日超过30天，整理导致住院日超过30天的原因并行Logistic回归分析。结果住院日超过30天患者主要集中于50～80岁（85.61%），食管与食管胃交界肿瘤（73.23%）和肺部肿瘤（25.00%）的患者。住院日延长的首要因素为术后并发症，其余因素依次为重要检查等待、术前合并症会诊等待、非手术工作日等待、医疗纠纷及转诊困难。呼吸衰竭、肺部感染、持续漏气、吻合口瘘、切口愈合不良、乳糜胸、胸腔积液或脓胸，非计划再次手术并发症为住院日延长的独立危险因素（P﹤0.01）。结论术后并发症是延长住院日的首要因素，食管及食管胃交界肿瘤患者术后并发症应受到重视，重要检查等待对住院日影响也较大，因此抓好围手术期医疗质量，提高医院各部门协同运行效率，对缩短平均住院日有重要意义。%Objective To analyze the profile of inpatients treated in the department of thoracic surgery of cancer hos-pital, and to investigate the influential factors concerning patients had a hospital stay time of over 30 d. Method Clinical profiles of 12 423 patients discharged from cancer hospital (CAMS) between 2010 and 2013 were collected. Of all those patients, 396 who had extended hospital stay>30 d were analyzed through multivariate Logistic regression analysis.Re-sult A predominant proportion of patients thathad>30 days of hospital stay were aged between 50~80(85.61%), and suf-fered from esophageal or esophagogastric junction tumors (73.23%), and pulmonary tumors (25.00%). Postoperative com-plication wasthe primary cause for extended hospital stay, followed byessential tests delay, consultation of complex preop-erative complications, non-surgical day delay, medical disputes and referral difficulties. Respiratory failure, pulmonary in-fection, thoracic air leakage, anastotomic leakage, poor wound healing, chylothorax, pleural effusion or empyema, compli-cations of unexpected reoperation were independentrisk factors that may contribute to extended hospital stay (P<0.01). Conclusion Postoperative complication takes a major part inextended hospital stay. The postoperative complications of esophageal or esophagogastric junction tumors, as well as essential tests delay should also be addressed accordingly. The shortening of average hospital stay relies on the improving of perioperative medical quality, and the amelioration of col-laborative efficiency among different departments.