Predicting appendiceal tumors among patients with appendicitis.
Predicting appendiceal tumors among patients with appendicitis.
复制标题
DOI：
10.1097/ta.0000000000001378
复制
发表时间：
2017-04-01
期刊：
影响因子：
--
通讯作者：
Jordan, Janeen R
中科院分区：
文献类型：
--
作者：
Loftus, Tyler J;Raymond, Steven L;Jordan, Janeen R
背景：随着阑尾炎非手术治疗的普及，对阑尾肿瘤的警惕变得越来越重要。我们假设，在患有急性阑尾炎的患者中，那些高龄、有多种合并症、表现不典型和复杂性阑尾炎的患者更有可能患有潜在的阑尾肿瘤。 方法：我们对在我们的三级护理中心因阑尾炎接受阑尾切除术的 677 名连续成年患者进行了 4 年回顾性队列分析。将最终病理报告中患有阑尾肿瘤的患者与没有肿瘤的患者进行比较。入院时的情况用于创建多变量逻辑回归模型来预测阑尾肿瘤。危险因素报告为比值比 (OR) [95% CI]。模型强度通过受试者工作特征曲线下面积进行评估。结果：17 名患者 (2.5%) 患有阑尾肿瘤。在这个群体之内。 14 名患者接受了立即阑尾切除术，两名患者最初接受了非手术治疗，但抗生素治疗效果不佳，并在初次入院时接受了阑尾切除术，一名患者在出院 19 天后成功进行了非手术治疗和择期阑尾切除术。四个变量有助于多变量模型预测阑尾肿瘤的存在：年龄≥50（OR 3.6 [1.1-11.4]），门诊类固醇/免疫抑制剂的使用（OR 12.1 [2.0-72.5]），无游走性右下腹疼痛（OR 4.7 [1.2-18.1]），以及CT扫描上出现蜂窝织炎（OR 7.0[1.6-30.2]）；受试者工作特征曲线下的模型面积：0.860 [0.705-0.969]。结论：对于患有急性阑尾炎的患者，入院时出现的情况可能预测潜在的阑尾肿瘤。高龄、多种合并症、表现不典型和复杂性阑尾炎的患者应在首次入院时考虑接受阑尾切除术，如果需要非手术治疗，则应尽早考虑接受阑尾切除术。证据级别：预后研究，III 级。
BACKGROUND: As nonoperative management of appendicitis gains popularity, vigilance for appendiceal tumors becomes increasingly important. We hypothesized that, among patients presenting with acute appendicitis, those with advanced age, multiple comorbidities, atypical presentation, and complicated appendicitis would be more likely to have underlying appendiceal tumors.METHODS: We performed a 4-year retrospective cohort analysis of 677 consecutive adult patients who underwent appendectomy for appendicitis at our tertiary care center. Patients with an appendiceal tumor on their final pathology report were compared to patients with no tumor. Conditions present on admission were used to create a multivariate logistic regression model to predict appendiceal tumor. Risk factors were reported as odds ratio (OR) [95% CI]. Model strength was assessed by area under the receiver operating characteristic curve.RESULTS: Seventeen patients (2.5%) had an appendiceal tumor. Within this group. 14 underwent immediate appendectomy, two initially had nonoperative management but failed to improve on antibiotics and underwent appendectomy during the initial admission, and one had successful nonoperative management and elective appendectomy 19 days after discharge. Four variables contributed to the multivariate model to predict the presence appendiceal tumor: age ≥ 50 (OR 3.6 [1.1-11.4]), outpatient steroid/immunosuppressant use (OR 12.1 [2.0-72.5]), the absence of migratory right lower quadrant pain (OR 4.7 [1.2-18.1]), and the appearance of a phlegmon on CT scan (OR 7.0 [1.6-30.2]); model area under the receiver operating characteristic curve: 0.860 [0.705-0.969].CONCLUSION: For patients presenting with acute appendicitis, conditions present on admission may predict underlying appendiceal tumor. Patients with advanced age, multiple comorbidities, atypical presentation, and complicated appendicitis should be considered for appendectomy during the index admission or at earliest convenience if nonoperative management is necessary.LEVEL OF EVIDENCE: Prognostic study, level III.