Velanovich V, Satava R
General Surgery Service, Madigan Army Medical Center, Tacoma, WA 98431.
Am Surg. 1992 Apr;58(4):264-9.
Debate continues as to what should be the appropriate "negative" appendectomy rate for patients suspected of having acute appendicitis. The controversy centers around balancing the complications of appendectomy for a normal appendix with those for a perforated appendix. By using a decision analysis approach to the probable outcomes of appendectomy for a normal appendix, acute appendicitis, and perforated appendicitis, this study provides one answer to this question. These outcomes are based on a review of the results of over 10,000 appendectomies. There is an inverse relationship between the normal appendectomy rate and perforated appendicitis rate. The overall complication rate in patients suspected of having appendicitis improved when the rate of perforated appendicitis was lowered, even if this meant raising the negative appendectomy rate. The perforation rate seemed to level off at approximately 10 per cent. The quality of surgical care delivered to a given population should not be judged solely on the normal appendectomy rate, but this rate should be interpreted in the light of the perforated appendicitis rate. Quality assurance assessments should focus first on perforated appendicitis and only later on normal appendectomy.
对于疑似患有急性阑尾炎的患者，合适的“阴性”阑尾切除率究竟应该是多少，目前仍存在争议。这场争论的焦点在于如何平衡正常阑尾切除的并发症与穿孔阑尾切除的并发症。通过对正常阑尾、急性阑尾炎和穿孔性阑尾炎进行阑尾切除可能产生的结果采用决策分析方法，本研究为这个问题提供了一个答案。这些结果基于对10000多例阑尾切除术结果的回顾。正常阑尾切除率与穿孔性阑尾炎发生率之间存在反比关系。当穿孔性阑尾炎发生率降低时，即使这意味着提高阴性阑尾切除率，疑似阑尾炎患者的总体并发症发生率也会有所改善。穿孔率似乎在大约10%时趋于平稳。不应仅根据正常阑尾切除率来评判给予特定人群的外科护理质量，而应结合穿孔性阑尾炎发生率来解读这一比率。质量保证评估应首先关注穿孔性阑尾炎，之后再关注正常阑尾切除。
