Taylor Michael, Emil Sherif, Nguyen Nam, Ndiforchu Fombe
Division of Pediatric Surgery, Department of Surgery, University of California, Irvine Children's Hospital, Orange, CA 92868-3298, USA.
J Pediatr Surg. 2005 Dec;40(12):1912-5. doi: 10.1016/j.jpedsurg.2005.08.005.
Emergent appendectomy (EA) in children is still considered surgical dogma and continues to be recommended as a standard of care. This study examined whether emergent operation has any outcome advantages over urgent operation.
The charts of children treated for appendicitis during a recent 28-month period at 2 children's hospitals, where appendectomies are not performed between midnight and 7 am, were reviewed. Outcomes were compared between patients who underwent EA (within 8 hours of presentation) vs those who underwent urgent appendectomy (UA, after 8 hours).
Three hundred sixty-five children met the criteria for the study. One hundred sixty-one (44%) were in the EA group (5.3 +/- 2.1 hours), and 204 (56%) were in the UA group (16.8 +/- 9.7 hours). The incidence of gangrenous or perforated appendicitis was significantly higher in the EA group (47% vs 36%, P = .04). There were no significant differences between EA and UA in postoperative outcomes, including readmissions (3.7% vs 1.0%, P = .08), wound infections (0.6% vs 2.4%, P = .17), or postoperative abscesses (1.9% vs 1.5%, P = .77). There were no significant differences in average hospital stay or average hospital charges between EA and UA (3.2 days for both, 14,775 dollars vs 14,850 dollars), respectively.
Emergent appendectomy in children has no advantages over UA with respect to gangrene and perforation rates, readmissions, postoperative complications, hospital stay, or hospital charges. Performance of a UA at a time convenient to the surgeon should be considered within the standard of care.
儿童急诊阑尾切除术（EA）仍被视为外科手术的既定做法，并继续被推荐为标准治疗方案。本研究旨在探讨急诊手术相对于紧急手术是否具有任何预后优势。
回顾了两家儿童医院在最近28个月期间接受阑尾炎治疗的儿童病历，这两家医院在午夜至上午7点之间不进行阑尾切除术。比较了接受EA（就诊后8小时内）的患者与接受紧急阑尾切除术（UA，就诊后8小时后）的患者的预后情况。
365名儿童符合研究标准。161名（44%）在EA组（5.3±2.1小时），204名（56%）在UA组（16.8±9.7小时）。EA组坏疽性或穿孔性阑尾炎的发生率显著更高（47%对36%，P = 0.04）。EA组和UA组在术后预后方面无显著差异，包括再入院率（3.7%对1.0%，P = 0.08）、伤口感染率（0.6%对2.4%，P = 0.17）或术后脓肿发生率（1.9%对1.5%，P = 0.77）。EA组和UA组在平均住院时间或平均住院费用方面也无显著差异（均为3.2天，分别为14,775美元对14,850美元）。
在坏疽和穿孔率、再入院率、术后并发症、住院时间或住院费用方面，儿童急诊阑尾切除术相对于紧急阑尾切除术并无优势。在标准治疗方案中，应考虑在外科医生方便的时间进行紧急阑尾切除术。
