Research On Factors Of Inappropriate Inpatient Days Of Pelvic Fracture Surgery Patients

Objectives: To describe the inappropriate inpatient days of pelvic fracture surgery patients.To analyse the impact of intravenous fluid(IV)on the application of Appropriate Evaluation Protocol(AEP).To describe the length of stay(LOS)of pelvic fracture surgery patients and analyse the influence of inappropriate stay on the research of the infactor of LOS.Methods: Palvic fracture surgery patients discharged 2013 in Trauma Centre of Shanghai General Hospital was slected as subjects.Case Information Chart was made to collect related information of subjects.US-AEP was used to evaluated the inappropriate stay.The result of AEP was adjusted by the ruslut of IV evaluation.The baseline of subjects was decribed.The difference between pre-adjusted and post-ajusted AEP result was compared.The wilcoxon rank sum test,spearman rank relative analysis and cox regression analysis were carried out on LOS,inappropriate stay and appropriate stay of subjects,to identify and compare the influence factors.Results: 65 cases were included.69.23% subjects were man,66.16% were yong and middle age and 33.85% were incharged because of traffic accident.Many subjects had complications.All subjects had 2911 IV theraies,1466 lab tests,130 X-ray exams,125 CT exams and 27 ultrasound scans.The total LOS of 65 subjects was 1294,mean LOS was 19.91±13.81 days and median LOS was 18(11-25)days.Month when admission,number of preventive IV fluid,number of normal blood test,average day of X-ray exams after admission,ilium fracture,operation method,fixation with scrws and rods,average volum of IV in surgeries,number of necessary general medication IV fluid were the independent factors of LOS(P<0.05).The length of inappropriate stay of 65 pelvic fracture patients were 317 days,24.50% of LOS,and the adjusted length of inappropriate stay were 527 days,40.73% of LOS.The difference between inappropriate stay and adjusted inappropriate stay was statistical significant(P<0.05).The inappropriateness of single stay was different in seasons and months(P<0.05).Nerve system injury,LOS,number of necessary antibiotic IV fluid,average day of lab tests after admission,average day of normal urine tests after admission,average day of X-ray exams after admission were the independent factors of the adjusted length of inappropriate stay(P<0.05).The total appropriate stay of 65 subjects was 767,59.27% of LOS,mean appropriate stay was 11.80±11.55 days and median appropriate stay was 9(5-14)days.Sacrum fracture,emergency surgery,systolic blood pressure when admission,average days of consultations,number of necessary general medication IV fluid,number of unnecessary electrolyte IV fluid,number of necessary palliative IV fluid,number of total IV fluid,average day of lab tests after admission,average day of blood clotting tests after admission,average day of X-ray exams after admission were the independent factors of the length of appropriate stay(P<0.05).Conclusions: The portion of the length of inappropriate stay versus LOS of pelvic fracture patient is high.The unnecessary IV fluid can affect the result of AEP and the AEP result should be adjusted based on the evalusation of IV fluid.The long LOS patients have long length of inappropriate stay.The severe patients may have shorter length of inappropriate stay.The inappropriate stay can affect the result on the research of factors of LOS.To investigate the relationship between disease,medical technology and LOS,the length of appropriate stay should be analysis as dependent variable.To investigate the relationship between management factors,other factors not included by disease or medical technology and LOS,the length of inappropriate stay should be analysis as dependent variable.Our research sets a new point in AEP localization.Our research offers a tool in LOS delicacy management for hospitals and authotitities.