Resultados preliminares de la implementación de un área del paciente quirúrgico complejo como herramienta para mejorar la calidad asistencial

IF 1.3 4区医学 Q3 SURGERY

Cirugia Espanola Pub Date : 2025-05-01 DOI:10.1016/j.ciresp.2025.01.003

Mihai-Calin Pavel , Ana Ferre , Lucia Garcia-Huete , Iban Oliva , Lluisa Guillem , Ignacio Tomas , Marcela Renzulli , Rosa Jorba-Martin

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Abstract

Introduction

Given the increasing complexity of surgical patients, their evaluation within a Complex Surgical Patient Area (APQC) is essential. This study aims to present the functioning of the APQC and analyze its outcomes.

Methods

Between 2022 and 2024, 73 patients were evaluated, with a mean age of 72.8 ± 10 years. Of these, 97.3% were ASA≥ III and 41.1% had a Clinical Frailty Score ≥4. The evaluation centered on a multidisciplinary committee responsible for determining the patient's operability and guiding the intrahospital circuit. During postoperative evolution, patient follow-up was carried out by 2 complementary teams in continuous communication. Failure to Rescue (FTR) was defined as the death of a patient following one or more serious complications.

Results

The main reason for including patients in the CSPA was multimorbidity in 53.4% of cases and a specific pathology in 28.8%. In 31.5% of cases, the intervention was ruled out, with one-year survival below 40%. Among the 35 operated patients, the Comprehensive Complication Index (CCI) was 18.034 ± 21.94, the average hospital stay was 14.34 ± 20.15 days, and the readmission rate was 25.7%. The FTR rate was 12.5%.

Conclusions

Current data suggest a positive impact of the APQC on the evolution of complex patients. A larger patient sample is needed for a detailed analysis of the factors where APQC activities may have the greatest influence.

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实施复杂外科患者区作为提高护理质量工具的初步结果

鉴于手术患者的复杂性日益增加，在复杂手术患者区（APQC）内对其进行评估是必不可少的。本研究旨在介绍APQC的功能，并分析其结果。方法在2022 - 2024年间，对73例患者进行评估，平均年龄为72.8±10岁。其中，97.3%的患者ASA≥III， 41.1%的患者临床虚弱评分≥4。评估集中在一个多学科委员会上，该委员会负责确定患者的可操作性并指导院内循环。术后随访过程中，由2个互补小组进行持续沟通。抢救失败（FTR）定义为患者在一种或多种严重并发症后死亡。结果入选CSPA的主要原因是多发病（53.4%）和特殊病理（28.8%）。31.5%的病例排除了干预，一年生存率低于40%。35例手术患者综合并发症指数（CCI）为18.034±21.94，平均住院时间为14.34±20.15 d，再入院率为25.7%。FTR利率为12.5%。结论目前的数据表明APQC对复杂患者的进化有积极的影响。为了详细分析APQC活动可能产生最大影响的因素，需要更大的患者样本。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Cirugia Espanola SURGERY-

CiteScore

1.20

自引率

21.10%

发文量

173

审稿时长

53 days

期刊介绍： Cirugía Española, an official body of the Asociación Española de Cirujanos (Spanish Association of Surgeons), will consider original articles, reviews, editorials, special articles, scientific letters, letters to the editor, and medical images for publication; all of these will be submitted to an anonymous external peer review process. There is also the possibility of accepting book reviews of recent publications related to General and Digestive Surgery.