Department of Surgery, Triemli Hospital Zurich, Birmensdorferstrasse, 8063, Zurich, Switzerland.
World J Surg. 2011 Jul;35(7):1626-33. doi: 10.1007/s00268-011-1101-z.
The influence of in-hospital delay (time between admission and operation) on outcome after appendectomy is controversial.
A total of 1,827 adult patients underwent open or laparoscopic appendectomy for suspected appendicitis in eleven Swiss hospitals between 2003 and 2006. Of these, 1,675 patients with confirmed appendicitis were included in the study. Groups were defined according in-hospital delay (≤12 vs. >12 h).
Delay>12 h was associated with a significantly higher frequency of perforated appendicitis (29.7 vs. 22.7%; P=0.010) whereas a delay of 6 or 9 h was not. Size of institution, time of admission, and surgical technique (laparoscopic vs. open) were independent factors influencing in-hospital delay. Admission during regular hours was associated with higher age, higher frequency of co-morbidity, and higher perforation rate compared to admission after hours. The logistic regression identified four independent factors associated with an increased perforation rate: age (≤65 years vs. >65 years, odds ratio (OR) 4.5, P<0.001); co-morbidity (Charlson index>0 vs. Charlson index=0, OR 2.3, P<0.001); time of admission (after hours vs. regular hours, OR 0.8, P=0.040), in-hospital delay (>12 vs. ≤12 h, OR 1.5, P=0.005). Perforation was associated with an increased reintervention rate (13.4 vs. 1.6%; P<0.001) and longer length of hospital stay (9.5 vs. 4.4 days; P<0.001).
In-hospital delay negatively influences outcome after appendectomy. In-hospital delay of more than 12 h, age over 65 years, time of admission during regular hours, and the presence of co-morbidity are all independent risk factors for perforation. Perforation was associated with a higher reintervention rate and increased length of hospital stay.
住院时间（入院至手术的时间）对阑尾切除术的结果有影响，但其影响一直存在争议。
2003 年至 2006 年间，瑞士 11 家医院对 1827 例疑似阑尾炎的成年患者进行了开放或腹腔镜阑尾切除术。其中，1675 例确诊为阑尾炎的患者被纳入研究。根据住院时间（≤12 小时与>12 小时）分为两组。
与住院时间≤12 小时相比，住院时间>12 小时与更高的穿孔性阑尾炎发生率（29.7%比 22.7%；P=0.010）显著相关，而 6 小时或 9 小时的住院时间并无差异。医院规模、入院时间和手术技术（腹腔镜与开放）是影响住院时间的独立因素。正常工作时间入院的患者年龄较大、合并症较多、穿孔率较高。与非正常工作时间入院相比，正常工作时间入院的患者年龄较大、合并症较多、穿孔率较高。逻辑回归分析确定了与穿孔率增加相关的四个独立因素：年龄（≤65 岁与>65 岁，比值比（OR）4.5，P<0.001）；合并症（Charlson 指数>0 与 Charlson 指数=0，OR 2.3，P<0.001）；入院时间（非正常工作时间与正常工作时间，OR 0.8，P=0.040）；住院时间（>12 小时与≤12 小时，OR 1.5，P=0.005）。穿孔与再次干预率（13.4%比 1.6%；P<0.001）和住院时间延长（9.5 天比 4.4 天；P<0.001）有关。
住院时间延迟对阑尾切除术的结果有负面影响。超过 12 小时的住院时间延迟、年龄大于 65 岁、正常工作时间入院以及合并症的存在是穿孔的独立危险因素。穿孔与更高的再次干预率和更长的住院时间有关。
