手術品質改善了嗎？2011年-2012年全國手術安全把關運動分析

Is Surgical Quality Improved? 2011-2012 Perioperative Surgical Safety Checklist Instituted in Taiwan

手術照護可防止生命喪失，但也伴隨併發症和死亡的風險，本文檢視全國手術安 全查核後之品質變化。利用2010-2012年醫院評鑑暨醫療品質策進會之手術安全把關活 動，各年平均每月85、67、64家醫院響應提報指標資料，選定手術把關達成率以及5項 成果指標包括：術後併發症、術後48小時內死亡率、30天內手術部位感染率、非計畫 性重返手術室以及劃刀前60分鐘內給預防性抗生素比率。以醫策會按月公告彙總全國 醫院提報資料，實施四個月（2010年9月-2010年12月）為基期，實施後第一年（2011 年1月-2011年12月）為前期，第二年（2012年1月-2012年12月）為後期，按醫院規模 分五類（<49床，50-99床，100-249床，250-499床，>500床）。採用SPSS 12.0軟體， 以描述性統計分析基期、前期、後期6項指標值（中位數）之變化。以手術把關達成率 之中位數二分為高遵從群和低遵從群，以獨立樣本T檢定比較兩群在5項手術品質的差 異。

Though surgical treatment can prevent loss of lives, it is also accompanied the risk of complications and deaths associated with surgery. The goal of this paper is to examine quality improvement after implemented a Surgical Safety Checklist (SSC) in Taiwan. Between October 2010 and December 2012, yearly eighty-five, sixty-seven, sixty-four hospitals participated in SSC project and monthly reported data on clinical processes and outcomes of inpatient after application of SSC. We collected data from Taiwan Joint Commission on Hospital Accreditation (TJCHA). The degree of complying with SSC and five outcomes indicators were include: the rate of postoperative complications, operative site infection rate after 30 days, the rate of unexpected return to the operation room, mortality rate within 48 hours after surgery, and Preoperative prophylactic antibiotic injection rate within 60 minutes. The first four months (September 2010-December 2010) after introduced SSC as the baseline period, (January 2011-December 2011) as early period and (January 2012-December 2012) as later period. The hospital were classified into 5 classes by size (＜49 beds, 50-99 beds, 100-249 beds, 250-499 beds, ＞500 beds). We analyzed the change of compliance and five surgery quality during a baseline and a 24-month period after implementation of SSC by using SPSS 12.0 software. The compliance was classified into high and low group by the median. We compare the differences of surgical quality between two groups by independent sample T-test. Our results showed overall, the compliance level has gradually increased (the median was 97.25%, 98.90%, 99.52%). Compared with the base period, operative site infection decreased from 0.30% to 0.23%, readmission decreased from 0.60% to 0.40%, 0.35%, use of preventive antibiotics before incision within 60 minutes rose from 90.10% to 92.25%, 96.44 %, postoperative complications from 0.60% up to 0.70%. The effect of the degree of compliance to SSC on the surgical quality disclosure the postoperative complication rate, readmission in early period at these hospitals with 250-499 beds, high compliance group significantly lower 0.85% than the low compliance group (p＜0.05), 0.14% (p＜0.05); but prophylactic antibiotics ratio in later period and operative site infection in baseline period at above 500 bed hospitals, high compliance group increased 1.30% (p＜0.01), 0.15% (p＜0.10) than the low compliance group; readmission, use of prophylactic antibiotics at hospitals with 100-249 bed in later, high compliance group higher 0.19% (p＜0.05), 1.86% (p＜0.10) than low group. The implementation of SSC did not show an absolutely result and significant difference between high and low compliance hospitals in our data. We consider that all hospitals might improve their surgical quality already due to early performance of Taiwan Hospital Accreditation. Further investigation for continuous use SSC is necessary.