腹腔镜阑尾切除术术后结局的改善：一项基于人群的、7446 例患者 12 年趋势分析。

Improving outcomes after laparoscopic appendectomy: a population-based, 12-year trend analysis of 7446 patients.

机构信息

Department of Visceral Surgery and Medicine, Bern University Hospitaland University of Bern, Bern, Switzerland.

出版信息

Ann Surg. 2011 Feb;253(2):309-13. doi: 10.1097/SLA.0b013e3181fc9d53.

DOI:10.1097/SLA.0b013e3181fc9d53

PMID:21173695

Abstract

OBJECTIVE

Laparoscopic appendectomy for acute appendicitis has become increasingly used over the past decade. The objective of this trend analysis is to assess whether clinical outcomes after laparoscopic appendectomy have improved over the past 12 years.

METHODS

This analysis is based on the prospective database of the Swiss Association of Laparoscopic and Thoracoscopic Surgery. All patients undergoing emergency laparoscopic appendectomy for acute appendicitis from 1995 to 2006 were included. The following outcomes were assessed for each of the 12 years: conversion rates, intraoperative complications, surgical postoperative complications, general postoperative complications, rate of reoperations, and length of hospital stay. Unadjusted and risk-adjusted multivariable analyses were performed. Statistical significance was set at a level of P < 0.05. All statistical tests were 2-sided.

RESULTS

Data from 7446 patients undergoing laparoscopic appendectomy for acute appendicitis were prospectively collected. Over the period of observation, the conversion rate decreased significantly from 2.2% to 1.2% (P(trend)< 0.001), as did intraoperative complications (from 3.1% to 0.7%; P(trend)< 0.001), surgical postoperative complications (from 6.1% to 1.9%; P(trend)< 0.001), general postoperative complications (from 4.9% to 1.5%; P(trend)< 0.001), and rates of reoperations (from 3.4% to 0.7%; P(trend)< 0.001). Average postoperative length of hospital stay also significantly decreased from 4.9 to 3.5 days (P(trend)< 0.001).

CONCLUSIONS

Our investigation provides compelling evidence that intraoperative complications, surgical and general postoperative complications, conversion rates, rates of reoperations, and average length of hospital stay have significantly decreased over the past decade in patients undergoing surgery for acute appendicitis. The present trend analysis is the first one in the literature encompassing more than a decade and reporting clinical outcomes after laparoscopic appendectomy for acute appendicitis, which represents an important quality control.

摘要

目的

腹腔镜阑尾切除术在过去十年中越来越多地被应用。本趋势分析的目的是评估过去 12 年来腹腔镜阑尾切除术后的临床结果是否有所改善。

方法

本分析基于瑞士腹腔镜和胸腔镜外科学会的前瞻性数据库。纳入了 1995 年至 2006 年间因急性阑尾炎行急诊腹腔镜阑尾切除术的所有患者。在过去的 12 年中，评估了每一年的以下结果：中转率、术中并发症、手术术后并发症、全身术后并发症、再手术率和住院时间。进行了未调整和风险调整的多变量分析。统计学意义设为 P < 0.05。所有统计检验均为双侧检验。

结果

前瞻性收集了 7446 例因急性阑尾炎行腹腔镜阑尾切除术患者的数据。在观察期间，中转率从 2.2%显著降至 1.2%（P<0.001），术中并发症（从 3.1%降至 0.7%；P<0.001）、手术术后并发症（从 6.1%降至 1.9%；P<0.001）、全身术后并发症（从 4.9%降至 1.5%；P<0.001）和再手术率（从 3.4%降至 0.7%；P<0.001）也显著降低。平均术后住院时间也从 4.9 天显著降至 3.5 天（P<0.001）。