Appendicitis in the modern era: universal problem and variable treatment
Appendicitis in the modern era: universal problem and variable treatment
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DOI：
10.1007/s00464-014-3882-2
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发表时间：
2015-07-01
影响因子：
3.1
通讯作者：
Tseng, Jennifer F.
中科院分区：
文献类型：
--
作者：
Bliss, Lindsay A.;Yang, Catherine J.;Tseng, Jennifer F.
急性阑尾炎是美国第二常见的需要紧急手术的胃肠道诊断。成人阑尾切除术的现状，包括患者和医院特征、并发症和并发症的预测因素，尚不清楚。对 2003-2011 年美国全国住院患者样本进行了阑尾切除术的回顾性审查，每千日元 18 岁。主要结局指标包括术后并发症、住院时间和患者死亡率。分类变量通过chi 2 进行分析，趋势分析通过Cochran-Armitage 进行。进行多变量逻辑回归以调整发生并发症的预测因素。发生了 1,663,238 例加权阑尾切除术出院。在研究期间，并发症从 3.2% 增加到 3.8% (p < 0.0001)，但总死亡率从 0.14% 下降到 0.09% (p < 0.0001)，平均 LOS 从 3.1 天减少到 2.6 天 (p < 0.0001)。腹腔镜阑尾切除术的比例随着时间的推移而增加，达到 41.7-80.1% (p < 0.0001)。患者年龄越来越大（千分之几65岁：9.4-11.6 %，p < 0.0001），肥胖程度越来越高（3.8-8.9 %，p < 0.0001），并且合并症也越来越多（Elixhauser分数千分之3：4.7-9.8 %，p < 0.0001）。调整后，术后并发症的独立预测因素包括：开放手术（OR 1.5，95 % CI 1.4-1.5）、男性（OR 1.6，95 % CI 1.5-1.6）、黑人种族（相对于白人：OR 1.5，95 % CI 1.4-1.6）、阑尾穿孔（OR 2.8，95 % CI 1.4-1.6） 2.7-3.0），更高的合并症（Elixhauser 千分之 3 与 0，OR 11.3，95 % CI 10.5-12.1），非私人保险状况（与私人保险相比：医疗补助 OR 1.3，95 % CI 1.2-1.4；医疗保险 OR 1.7，95 % CI 1.6-1.8），增加年龄（> 52 岁与千分之一货币符号27：OR 1.3；95 % CI 1.2-1.4）和医院数量（与高：低 OR 1.2；95 % CI 1.1-1.3）。腹腔镜阑尾切除术的预测因素包括年龄、种族、保险状况、合并症和医院地点。腹腔镜阑尾切除术正在增加，但在患者群体中的部署不均衡。阑尾切除术患者年龄越来越大，合并症越来越多，肥胖率也越来越高。黑人患者和有公共保险的患者腹腔镜使用率较低，结果较差。
Acute appendicitis is the second most common gastrointestinal diagnosis mandating urgent operation in the U.S. The current state of adult appendectomy, including patient and hospital characteristics, complications, and predictors for complications, are unknown.Retrospective review of U.S. Nationwide Inpatient Sample 2003-2011 for appendectomy in a parts per thousand yen18-year-olds was performed. Primary outcomes measures included postoperative complications, length of stay, and patient mortality. Categorical variables were analyzed by chi 2, trend analyses by Cochran-Armitage. Multivariable logistic regression was performed to adjust for predictors of developing complications.1,663,238 weighted appendectomy discharges occurred. Over the study period, complications increased from 3.2 to 3.8 % (p < 0.0001), but the overall mortality decreased from 0.14 to 0.09 % (p < 0.0001) and mean LOS decreased from 3.1 to 2.6 days (p < 0.0001). The proportion of laparoscopic appendectomy increased over time, 41.7-80.1 % (p < 0.0001). Patients were increasingly older (a parts per thousand yen65 years: 9.4-11.6 %, p < 0.0001), more obese (3.8-8.9 %, p < 0.0001), and with more comorbidities (Elixhauser score a parts per thousand yen3: 4.7-9.8 %, p < 0.0001). After adjustment, independent predictors for postoperative complications included: open surgery (OR 1.5, 95 % C.I. 1.4-1.5), male sex (OR 1.6, 95 % CI 1.5-1.6), black race (vs. white: OR 1.5, 95 % CI 1.4-1.6), perforated appendix (OR 2.8, 95 % CI 2.7-3.0), greater comorbidity (Elixhauser a parts per thousand yen3 vs. 0, OR 11.3, 95 % CI 10.5-12.1), non-private insurance status (vs. private: Medicaid OR 1.3, 95 % CI 1.2-1.4; Medicare OR 1.7, 95 % CI 1.6-1.8), increasing age (> 52 years vs. a parts per thousand currency sign27: OR 1.3; 95 % CI 1.2-1.4), and hospital volume (vs. high: low OR 1.2; 95 % CI 1.1-1.3). Predictors of laparoscopic appendectomy were age, ethnicity, insurance status, comorbidities, and hospital location.Laparoscopic appendectomy is increasing but is unevenly deployed across patient groups. Appendectomy patients were increasingly older, with more comorbidities and with increasing rates of obesity. Black patients and patients with public insurance had less utilization of laparoscopy and inferior outcomes.