Somme Stig, To Teresa, Langer Jacob C
Department of Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada M5G 1X8.
J Pediatr Surg. 2007 Jan;42(1):221-6. doi: 10.1016/j.jpedsurg.2006.09.044.
BACKGROUND/PURPOSE: There have been few studies documenting the effect of subspecialty training on outcomes after appendectomy in children. Some studies have suggested a better outcome in patients managed by pediatric surgeons as compared with general surgeons.
We studied the effect of subspecialty training on clinical outcome and negative appendectomy rate after pediatric appendectomy. Children less than 19 years in Ontario who underwent appendectomy were identified. Outcomes were compared between pediatric and general surgeons. Subanalyses were conducted for the age groups 0 to 5, 6 to 12, and 13 to 18 years.
Over 8 years, 24,019 children underwent appendectomy with a preoperative diagnosis of appendicitis. Of these, 21,027 had appendicitis. General surgeons performed 81.2% of the operations. Negative appendectomy rates were 8.3% and 13.4% (P < .0001) in the pediatric and general surgeon groups, respectively. Children operated on by pediatric surgeons were younger (10.5 +/- 3.6 vs 12.8 +/- 3.8; P < .05), more likely to be perforated (36.6% vs 32.0%; P < .0001), and had a longer postoperative stay (3.8 vs 3.0 days; P < .0001). There was no difference between groups with respect to wound infection or readmission rate when age and perforation status were accounted for.
Pediatric surgeons performed significantly fewer negative appendectomies than general surgeons. Although pediatric surgeons kept their patients longer in the hospital, their patients' wound infection and readmission rates were not different from that of the patients of general surgeons.
背景/目的：很少有研究记录亚专业培训对儿童阑尾切除术后结局的影响。一些研究表明，与普通外科医生相比，由小儿外科医生治疗的患者结局更好。
我们研究了亚专业培训对小儿阑尾切除术后临床结局和阴性阑尾切除率的影响。确定了安大略省19岁以下接受阑尾切除术的儿童。比较了小儿外科医生和普通外科医生的结局。对0至5岁、6至12岁和13至18岁年龄组进行了亚组分析。
在8年多的时间里，24,019名儿童接受了术前诊断为阑尾炎的阑尾切除术。其中，21,027名患有阑尾炎。普通外科医生进行了81.2%的手术。小儿外科医生组和普通外科医生组的阴性阑尾切除率分别为8.3%和13.4%（P < .0001）。由小儿外科医生手术的儿童年龄更小（10.5 ± 3.6岁 vs 12.8 ± 3.8岁；P < .05），穿孔的可能性更大（36.6% vs 32.0%；P < .0001），术后住院时间更长（3.8天 vs 3.0天；P < .0001）。在考虑年龄和穿孔状态时，两组在伤口感染或再入院率方面没有差异。
小儿外科医生进行的阴性阑尾切除术明显少于普通外科医生。尽管小儿外科医生让他们的患者住院时间更长，但他们患者的伤口感染和再入院率与普通外科医生的患者没有差异。
