中国普外基础与临床杂志

中国普外基础与临床杂志

数据库研究第二部分:结直肠癌的住院流程管理

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目的分析目前版本的华西肠癌数据库(Database from Colorectal Cancer,DACCA)中,华西医院作为区域性医疗中心所服务的结直肠癌患者的住院流程管理的特点。方法本次数据分析选取的 DACCA 版本为 2019 年 1 月 29 日更新版,其中数据项目包括:就诊日期、入院日期、手术日期、出院日期、入院前等候时间、术前住院时间、术后住院时间、住院总时间及管理流程,分别对各选取的数据项目作特征分析。结果按照条件筛选 DACCA 数据库获得 8 193 条可分析数据行。其中,“就诊日期”有效数据 3 915 条,“入院日期”有效数据8 144 条,“手术日期”有效数据 8 049 条,“出院日期”有效数据 7 958 条。入院前等待时间为(9.41±0.43)d,按照日期变化趋势的线性预测分析结果示,R2=0.101 257,P<0.001。术前住院时间为(5.41±0.04)d,按照日期变化趋势的线性预测分析结果示,R2=0.023 671,P<0.001。术后住院时间为(8.99±0.07)d,按照日期变化趋势的线性预测分析结果示, R2=0.086 177,P<0.001。住院总时间为(14.43±0.08)d,按照日期变化趋势的线性预测分析结果示,R2=0.098 44,P<0.001。DACCA 数据库中可以分析的有效 ERAS 数据为 2 368 条,其中可以达到分析条件的完全 ERAS 数据 2 368 条,顺利实施 108 条(5%),未顺利实施 2 260 条(95%);达到分析条件的围手术期 ERAS 数据2 260 条,顺利实施 150 条(7%),未顺利实施 2 110 条(93%);达到分析条件的术后 ERAS 数据 2 110 条,顺利实施 170 条(8%),未顺利实施 1 940 条(92%)。结论DACCA 数据库反映近 20 年来,本中心住院患者的术前等待、术后观察和住院总时间有下降趋势,服务结直肠癌患者的总体能力提高。ERAS 在本中心的临床应用度升高,并逐步成为最主要的住院管理流程。

ObjectiveBased on recently update Database from Colorectal Cancer (DACCA), we aimed to analyze the characteristics of in-hospital process management from reginal medical center’s colorectal cancer patients.MethodsWe used Version January 29th, 2019 of DACAA being the analyzing source. The items were included date of first out-patient meeting, admitted date, operative date, discharged date, waiting-time, preoperative staying days, postoperative staying days, hospital staying days, and manage protocol, whose characteristics would be analyzed.ResultsWe left 8 913 lines to be analyzed by filtering DACCA. Useful data lines of first out-patient meeting had 3 915, admitted date had 8 144, operative date had 8 049, and discharged date had 7 958. The average of waiting-time were (9.41±0.43) days, and based on timeline trend for line prediction analyzing, which showed R2=0.101 257, P<0.001. The average of preoperative staying days were (5.41±0.04) days, and based on timeline trend for line prediction analyzing, which showed R2=0.023 671, P<0.001. The average of postoperative staying days were (8.99±0.07) days, and based on timeline trend for line prediction analyzing, which showed R2=0.086 177, P<0.001. The average of hospital staying days were (14.43±0.08) days, and based one timeline trend of line prediction analyzing, which showed R2=0.098 44, P<0.001. Analyzable ERAS data were 2 368 lines in DACCA. Total EARS data in 2 368 lines, there were 108 lines (5%) completed and 2 260 lines (95%) incomplete. Pre/post ERAS data in 2 260 lines, there were 150 lines (7%) completed and 2 110 lines (93%) incomplete. Post ERAS data in 2 110 lines, there were 170 lines (8%) completed and 1 940 lines (92%) incomplete.ConclusionsIn recent 20 years, the regional medical center served in-hospital colorectal cancer patients with decreased preoperative staying days, postoperative staying days, and in-hospital staying days from DACCA analyzing, which could prove the service ability had been in improved. Utilization rate of EARS was increased, and also being the main in-hospital process management.

关键词: 结直肠癌; 数据库; 大数据; 医疗流程; 加速康复外科

Key words: colorectal cancer; database; bigdata; medical process; enhanced recovery after surgery

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