臺灣博碩士論文加值系統

麻醉為手術必要且高風險之醫療行為，麻醉術前評估為不適合接受手術麻醉的病人安全把關並建議取消手術，本研究運用個案醫院手術取消紀錄資料，分析手術取消原因並探討其與科別、病人特性之可能關係。研究材料為國內某醫學中心麻醉部建置之資料庫，研究期間為2007年1月1日至12月31日，進入手術排程共61,857人次，包含手術施行61,629人次及手術取消228人次。
研究結果顯示整體手術取消率為0.37%，依來源別區分門診手術取消率與住院手術取消率分別為0.54%及0.33%。手術取消原因以病人因素為最多佔70.2%，其次為心血管問題(18%)及肺部問題(9.6%)。婦科為手術取消比例最高的手術科別(21.9%)，其次為骨科(16.9%)及泌尿外科(10.9%)。47.5%的手術取消病人於手術取消後一個月內復行手術。
結論為手術取消率隨著年齡增加而上升，門診手術有較高的手術取消率，婦科、骨科與泌尿外科因病人因素及心血管問題之暫時性手術取消原因，為改善手術取消及提升麻醉服務品質持續努力的方向。

Anesthesia is a necessary and risky procedure for surgery. The preanesthesia evaluation ensure the safety of patient.The purpose of this study is to examine the possible relationship between case cancellation, specialty, and patients’ characters. The present data was derived from the department of anesthesiology at a medical center in Taiwan. The study period was between January 1 and December 31 2007. A total of 61,857 patients scheduled for operation and of 228 were cancelled cases.
The overall surgery cancellation rate were 0.37% and 0.54% for outpatients and 0.33% for inpatients. Main reasons for cancellation were: patient factor (70.2%); cardiovasculer problem (18%); and pulmonary problem (9.6%). Gynecology experienced the most cancellation (21.9%), followed by orthopedics (16.9%) and urology (10.9%). Nearly half of the cancelled case had surgery within 1 month.
The conclusions are that surgery cancellation rate increases with age. There are higher surgery cancellation rate in outpatient operations than inpatients’. Further effort can be taken to temporary causes about patient factors and cardiovasculer problems in gynecology, orthopedics and urologyfor for continuing quality improvement of anesthesia.

指導教授推薦書
口試委員會審定書
長庚大學博碩士論文著作授權書 iii
誌謝 iv
中文摘要 v
Abstract vi
目錄 vii
第一章 緒論 1
第一節 研究背景 1
第二節 研究目的 3
第二章 文獻探討 4
第一節 外科手術的必要性與評估 4
第二節 麻醉服務 5
第三節 麻醉術前評估 7
第四節 手術取消原因與相關實證研究 8
第五節 文獻小結 9
第三章 研究方法 10
第一節 研究材料與變項 10
第二節 分析方法 11
第四章 結果與討論 12
第一節 樣本基本特性資料 12
第二節 手術取消分析 16
第三節 研究限制 22
第五章 結論與建議 23
第一節 結論 23
第二節 建議 23
參考文獻 27
附錄 29

圖目錄
圖一 麻醉術前評估門診功能概念圖 24

表目錄
表一 研究變項定義說明 11
表二 手術取消與手術施行病人基本特性 15
表三 手術取消原因分類 17
表四 手術取消原因－病人因素 17
表五 手術取消原因依手術科別分析 18
表六 手術取消後復行手術個案之分析 21

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