阑尾炎用抗生素！别急着下结论。

Antibiotics for appendicitis! Not so fast.

作者信息

Khalil Mazhar, Rhee Peter, Jokar Tahereh Orouji, Kulvatunyou Narong, O'Keeffe Terence, Tang Andrew, Hassan Ahmed, Gries Lynn, Latifi Rifat, Joseph Bellal

机构信息

From the Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, University of Arizona, Tucson, Arizona.

出版信息

J Trauma Acute Care Surg. 2016 Jun;80(6):923-32. doi: 10.1097/TA.0000000000001030.

DOI:10.1097/TA.0000000000001030

PMID:26958796

Abstract

BACKGROUND

Emerging literature in acute appendicitis favors the nonoperative management of acute appendicitis. However, the actual use of this practice on a national level is not assessed. The aim of this study was to assess the changing trends in nonoperative management of acute appendicitis and its effects on patient outcomes.

METHODS

We did an 8-year (2004-2011) retrospective analysis of the National Inpatient Sample database. We included all inpatients with the diagnosis of acute appendicitis. Patients with a diagnosis of appendiceal abscess or patients who underwent surgery for any other pathology were excluded from the analysis. Jonckheere-Terpstra trend analysis was performed for operative versus nonoperative management and outcomes.

RESULTS

A total of 436,400 cases of acute appendicitis were identified. Mean age of the population was 33 ± 19.5 years, and 54.5% were male. There was no significant change in the number of acute appendicitis diagnosed over the study period (p = 0.2). During the study period, nonoperative management of acute appendicitis increased significantly from 4.5% in 2004 to 6% in 2011 (p < 0.001). When compared with operatively managed patients, conservatively managed patients had a significantly longer hospital length of stay (3 [2-6] vs. 2 [1-3] days, p < 0.001), and in-hospital complications (27.8% vs. 7%, p < 0.001). On comparison of open and laparoscopic appendectomy, both had shorter hospital length of stay and rate of in-hospital complications. Overall hospital charges were lower in patients managed conservatively (15,441 [8,070-31,688] vs. 20,062 [13,672-29,928] USD, p < 0.001).

CONCLUSIONS

Nonoperative management of appendicitis has increased over time; however, outcomes of nonoperative management did not improve over the study period. A more in-depth analysis of patient and system demographics may reveal this disparity in trends.

LEVEL OF EVIDENCE

Epidemiologic/prognostic study, level III.

摘要

背景

关于急性阑尾炎的最新文献支持对急性阑尾炎进行非手术治疗。然而，尚未评估这种治疗方法在全国范围内的实际应用情况。本研究的目的是评估急性阑尾炎非手术治疗的变化趋势及其对患者预后的影响。

方法

我们对国家住院患者样本数据库进行了为期8年（2004 - 2011年）的回顾性分析。纳入所有诊断为急性阑尾炎的住院患者。诊断为阑尾脓肿的患者或因任何其他病理情况接受手术的患者被排除在分析之外。对手术治疗与非手术治疗及预后进行了Jonckheere - Terpstra趋势分析。

结果

共确定了436,400例急性阑尾炎病例。患者的平均年龄为33 ± 19.5岁，其中54.5%为男性。在研究期间，诊断出的急性阑尾炎病例数没有显著变化（p = 0.2）。在研究期间，急性阑尾炎的非手术治疗从2004年的4.5%显著增加到2011年的6%（p < 0.001）。与接受手术治疗的患者相比，接受保守治疗的患者住院时间显著更长（3 [2 - 6]天对2 [1 - 3]天，p < 0.001），且住院并发症发生率更高（27.8%对7%，p < 0.001）。比较开放阑尾切除术和腹腔镜阑尾切除术，两者的住院时间和住院并发症发生率都较短。保守治疗患者的总体住院费用较低（15,441 [8,070 - 31,688]美元对20,062 [13,672 - 29,928]美元，p < 0.001）。