Is nonoperative management of appendicitis safe and effective in multi-morbid patients?
Is nonoperative management of appendicitis safe and effective in multi-morbid patients?
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对于多病患者，阑尾炎的非手术治疗安全有效吗？
DOI：
10.1016/j.surg.2023.10.017
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发表时间：
2024
期刊：
影响因子：
3.8
通讯作者：
Balentine,CourtneyJ
中科院分区：
文献类型：
--
作者：
Lunardi,Nicole;Meier,Jennie;Pham,ThaiH;Zarzaur,BenL;Agarwal,Suresh;Sharath,Sherene;Kougias,Panos;Balentine,CourtneyJ
背景本研究的目的是（1）比较急性阑尾炎多发病患者手术和非手术治疗的治疗后结果;（2）通过确定多发病患者的结果是否不同，评价先前临床试验的普遍性。与年轻和健康的患者谁类似以前的临床试验参与者相比，病态患者。从2004年到2017年的样本。我们纳入了368，537例急性无并发症阑尾炎患者，这些患者被分类为0或2+合并症。我们使用倾向评分比较住院患者的发病率、死亡率、住院时间和费用。未测量的混杂处理概率敏感性analysis.ResultsOverall，5%的患者没有合并症进行非手术治疗，与20%的多发病患者。与手术相比，非手术治疗与并发症减少3.5%（95%置信区间3%-4%）的多病患者，但没有合并症的患者没有显着差异。然而，非手术治疗与多病患者死亡率增加1.5%相关（95%置信区间1.3%-1.7%）。所有接受手术治疗的患者的费用和住院时间都较低。概率敏感性分析表明，结果是强大的影响unmeasured confounding.ConclusionOur结果引起关注的临床试验，比较非手术和手术治疗阑尾炎的普遍性，因为（1）这些试验招募大多是年轻和健康的患者，（2）结果在多发病患者不同的结果在年轻和健康的患者。
BackgroundThe purpose of this study was to (1) compare post-treatment outcomes of operative and nonoperative management of acute appendicitis in multi-morbid patients and (2) evaluate the generalizability of prior clinical trials by determining whether outcomes differ in multi-morbid patients compared to the young and healthy patients who resemble prior clinical trial participants.MethodsWe conducted a retrospective cohort study using the National Inpatient Sample from 2004 to 2017. We included 368,537 patients with acute, uncomplicated appendicitis who were classified as having 0 or 2+ comorbidities. We compared inpatient morbidity, mortality, length of stay, and costs using propensity scores. Unmeasured confounding was addressed with probabilistic sensitivity analysis.ResultsOverall, 5% of patients without comorbidities were treated nonoperatively versus 20% of multi-morbid patients. Compared to surgery, nonoperative management was associated with a 3.5% decrease in complications (95% confidence interval 3%–4%) for multi-morbid patients, but there was no significant difference for patients without comorbidity. However, nonoperative management was associated with a 1.5% increase in mortality for multimorbid patients (95% confidence interval 1.3%–1.7%). Costs and length of stay were lower for all patients treated with surgery. Probabilistic sensitivity analysis showed that results were robust to the effects of unmeasured confounding.ConclusionOur results raise concerns about the generalizability of clinical trials that compared nonoperative and operative management of appendicitis because (1) those trials enrolled mostly young and healthy patients, and (2) results in multi-morbid patients differ from outcomes in younger and healthier patients.