開刀房手術延期或取消之原因探討

背 景： 現代醫學追求醫療品質。其中，手術或麻醉安全，最為大眾關心。在眾多議題中，本文以手術被延遲或取消原因為題，探討及追蹤病患的結果。研究目的：在手術室，手術因許多不同原因延期或取消。通過使用資料庫的數據，我們追蹤並探討病患的各種結果，以期改進醫療品質。設 計：回溯性分析。設 置：醫學中心，大學附設醫院。方 法：本文從資料庫中(麻醉發病率和死亡率紀錄)，回顧並收集5年期手術室之資料。從手術被延期或取消的資料，分析延期或取消發生原因，並透過病歷或電話追蹤最長6個月，以瞭解每位病患最後結果。結 果：5年期間，共計45,663次手術需麻醉。其中，在手術室內延期或取消之手術患者共有67名(0.15%)。33名(49.3%)延期，延期時間分別從1天到6個月(中間數=8天)。取消預定手術患者21名(31.3%)。9名(13.4%)患者住院治療中死亡(平均數=12.7天;範圍：1-20天)。2名（3.0％）患者改以局部麻醉進行手術。2名（3.0％）患者失聯無法追蹤。結 論：延期或取消手術之主要原因為醫療狀況改變共47次（70.2％）；延期手術(中位數8天)共33次（49.3％）未執行手術共21次（31.3％）。未執行手術主要原因：1、該計劃手術尚未充分完成術前之評估；2、醫療風險大或另有替代手術之治療方法。

Topic: Analysis for the Reasons of Postponement or Cancellation of Surgery in the Operating RoomStudy Object: To analyze the reasons for postponement or cancellation of surgery in the operating room (OR), and to determine the effect on patient outcomes.Design: Retrospective analysis.Setting: University-affiliated hospital.Measurements: Over a 5-year period, 45,663 surgeries requiring anesthesia occurred. Surgery was postponed or cancelled in the OR for 67 patients (0.15%). Airway problems, change in medical condition, and change in surgical condition were the reasons recorded. Each patient''s surgical result was audited using medical charts and telephone calls for at least 6 months.Main Results: 33 cases (49.3%) were postponed from one day to 6 months (range, one to 165 days; median, 8 days). The scheduled surgeries for 21 (31.3%) patients were never performed; and 9 patients (13.4%) died during their hospitalization (range, one to 20 days; mean, 12.7 days).Conclusions: Surgery was postponed or cancelled in the OR mainly for changes in medical condition (70.2%); either medical risk outweighed the benefits of surgery, or alternative treatments were used.