Tashiro Jun, Einstein Stephanie A, Perez Eduardo A, Bronson Steven N, Lasko David S, Sola Juan E
Division of Pediatric Surgery, DeWitt-Daughtry Department of Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, FL.
South Florida Pediatric Surgeons, P.A., Plantation, FL.
J Pediatr Surg. 2016 May;51(5):804-9. doi: 10.1016/j.jpedsurg.2016.02.028. Epub 2016 Feb 12.
We hypothesize that laparoscopic (LA) or open appendectomy (OA) outcomes are associated with hospital procedure preference.
We queried Kids' Inpatient Database (1997-2009) for simple (ICD-9-CM 540.9) and complicated (540.0, 540.1) appendicitis.
On PS-matched analysis of simple appendicitis (91,118 LA vs. 97,496 OA), LA had increased transfusion (1.7) rates, but lower wound infection (0.6) and perforation/laceration (0.3) rates. LA had shorter length of stay (LOS; 1.7 vs. 2.1days), but higher total charges (TC; 19,501 vs. 13,089 USD) and cost (7121 vs. 5968) vs. OA. For complicated appendicitis (28,793 LA vs. 30,782 OA), LA had increased nausea/vomiting rates (1.9), but lower wound infection (0.5) and transfusion (0.6) rates. LA had shorter LOS (5.1 vs. 5.9), but higher TC (32,251 vs. 28,209). MVA demonstrated shorter LOS (0.9) for LA at laparoscopic-preferring hospitals vs. open-preferring hospitals for simple appendicitis. For complicated appendicitis, higher complication rates (1.1) were associated with OA at laparoscopic-preferring hospitals. Laparoscopic-preferring hospitals had higher TC in all categories.
Complications and resource utilization for appendicitis are associated with surgical technique and hospital procedure preference. Laparoscopic-preferring hospitals had higher complication rates with OA for complicated appendicitis and higher charges regardless of appendectomy technique or appendicitis type.
2c, Outcomes Research.
我们假设腹腔镜阑尾切除术（LA）或开腹阑尾切除术（OA）的结果与医院的手术偏好有关。
我们查询了儿童住院数据库（1997 - 2009年）中单纯性（ICD - 9 - CM 540.9）和复杂性（540.0、540.1）阑尾炎的数据。
在对单纯性阑尾炎进行倾向得分匹配分析时（91,118例LA与97,496例OA），LA的输血率（1.7）升高，但伤口感染率（0.6）和穿孔/撕裂率（0.3）较低。与OA相比，LA的住院时间较短（LOS；1.7天对2.1天），但总费用（TC；19,501美元对13,089美元）和成本（7121对5968）较高。对于复杂性阑尾炎（28,793例LA与30,782例OA），LA的恶心/呕吐率升高（1.9），但伤口感染率（0.5）和输血率（0.6）较低。LA的住院时间较短（5.1天对5.9天），但总费用较高（32,251美元对28,209美元）。多变量分析显示，在倾向于腹腔镜手术的医院中，对于单纯性阑尾炎，LA的住院时间较短（0.9天）。对于复杂性阑尾炎，在倾向于腹腔镜手术的医院中，OA的并发症发生率较高（1.1）。倾向于腹腔镜手术的医院在所有类别中的总费用都较高。
阑尾炎的并发症和资源利用与手术技术及医院的手术偏好有关。对于复杂性阑尾炎，倾向于腹腔镜手术的医院采用OA时并发症发生率较高，且无论阑尾切除术技术或阑尾炎类型如何，费用都较高。
2c，结果研究。
