Antibiotics for appendicitis! Not so fast
Antibiotics for appendicitis! Not so fast
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DOI：
10.1097/ta.0000000000001030
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发表时间：
2016-06-01
影响因子：
3.4
通讯作者：
Joseph, Bellal
中科院分区：
文献类型：
--
作者：
Khalil, Mazhar;Rhee, Peter;Joseph, Bellal
背景急性阑尾炎的新文献支持急性阑尾炎的非手术治疗。然而，没有评估这种做法在国家一级的实际使用情况。本研究的目的是评估急性阑尾炎非手术治疗的变化趋势及其对患者预后的影响。我们对全国住院患者样本数据库进行了8年（2004-2011年）的回顾性分析。我们纳入了所有诊断为急性阑尾炎的住院患者。诊断为阑尾脓肿的患者或因任何其他病理而接受手术的患者从分析中排除。Jonckheere-Terpstra趋势分析进行手术与非手术的管理和outcomes.Results共436,400例急性阑尾炎被确定。人口的平均年龄为33 - 19.5岁，54.5%为男性。在研究期间，诊断的急性阑尾炎的数量没有显著变化（p = 0.2）。在研究期间，急性阑尾炎的非手术治疗从2004年的4.5%显著增加到2011年的6%（p < 0.001）。与手术治疗患者相比，保守治疗患者的住院时间明显更长（3 [2-6] vs. 2 [1-3]天，p < 0.001），住院并发症发生率（27.8% vs. 7%，p < 0.001）。开腹阑尾切除术与腹腔镜阑尾切除术比较，两者住院时间及院内并发症发生率均较短。保守治疗患者的总住院费用较低（15，441 [8，070 - 31，688] vs. 20，062 [13，672 - 29，928] USD，p < 0.001）。结论阑尾炎的非手术治疗随着时间的推移而增加;然而，非手术治疗的结果在研究期间并没有改善。对患者和系统人口统计学的更深入分析可能揭示这种趋势的差异。证据等级流行病学/预后研究，III级。
Background Emerging literature in acute appendicitis favors the nonoperative management of acute appendicitis. However, the actual use of this practice on a national level is not assessed. The aim of this study was to assess the changing trends in nonoperative management of acute appendicitis and its effects on patient outcomes.Methods We did an 8-year (2004-2011) retrospective analysis of the National Inpatient Sample database. We included all inpatients with the diagnosis of acute appendicitis. Patients with a diagnosis of appendiceal abscess or patients who underwent surgery for any other pathology were excluded from the analysis. Jonckheere-Terpstra trend analysis was performed for operative versus nonoperative management and outcomes.Results A total of 436,400 cases of acute appendicitis were identified. Mean age of the population was 33 19.5 years, and 54.5% were male. There was no significant change in the number of acute appendicitis diagnosed over the study period (p = 0.2). During the study period, nonoperative management of acute appendicitis increased significantly from 4.5% in 2004 to 6% in 2011 (p < 0.001). When compared with operatively managed patients, conservatively managed patients had a significantly longer hospital length of stay (3 [2-6] vs. 2 [1-3] days, p < 0.001), and in-hospital complications (27.8% vs. 7%, p < 0.001). On comparison of open and laparoscopic appendectomy, both had shorter hospital length of stay and rate of in-hospital complications. Overall hospital charges were lower in patients managed conservatively (15,441 [8,070-31,688] vs. 20,062 [13,672-29,928] USD, p < 0.001).Conclusions Nonoperative management of appendicitis has increased over time; however, outcomes of nonoperative management did not improve over the study period. A more in-depth analysis of patient and system demographics may reveal this disparity in trends.Level of Evidence Epidemiologic/prognostic study, level III.