Tseng Chien-Jen, Sun Ding-Ping, Lee I-Chen, Weng Shih-Feng, Chou Chia-Lin
From the Division of General Surgery (C-JT), Department of Surgery, Chi Mei Hospital Chiali; Division of General Surgery (D-PS, C-LC), Department of Surgery, Chi Mei Medical Center, Tainan; Division of Colon and Rectal Surgery (C-LC), Department of Surgery, Taipei Veterans General Hospital and National Yang-Ming University, Taipei; Department of Healthcare Administration and Medical Informatics (I-CL), Kaohsiung Medical University, Kaohsiung; Department of Medical Research (S-FW), Chi Mei Medical Center; and Department of Hospital and Health Care Administration (S-FW), Chia-Nan University of Pharmacy and Science, Tainan, Taiwan.
Medicine (Baltimore). 2016 May;95(18):e3541. doi: 10.1097/MD.0000000000003541.
Postoperative small bowel obstruction (SBO) is a common complication of appendectomy. This study aimed to assess risk factors for SBO following appendectomy.This retrospective cohort study used the 2006 to 2008 Taiwan National Health Insurance Research Database. We evaluated adult patients with acute appendicitis who underwent open (OA) or laparoscopic appendectomy (LA) between January 1, 2006 and December 31, 2008. Excluded were patients with a history of abdominal surgery and SBO before the index operation, or abdominal surgery between the appendectomy and initial diagnosis of bowel obstruction as an identifiable cause of SBO. Factors thought to influence postoperative SBO were highlighted. The OA and LA cohorts were matched by propensity score, and the hazard ratios (HRs) and 95% confidence interval (CIs) of SBO were calculated.We enrolled 11,289 patients who underwent OA, and 11,289 matched controls who underwent LA. OA patients had significant risk of adhesive SBO compared with the LA group (adjusted HR: 1.7, 95% CI: 1.11-2.63). Further analysis revealed that that female sex (adjusted HR: 1.79, 95% CI: 1.17-2.72), CCI score of 1 or ≥2 (adjusted HR: 3.16, 95% CI: 1.76-5.67; adjusted HR: 4.03, 95% CI: 1.57-10.34), complicated appendicitis (adjusted HR: 1.68, 95% CI: 1.05-2.69), treatment in district hospitals increased risk of adhesive SBO.Female sex, complicated appendicitis, more comorbidities, and treatment in district hospitals are factors associated with a risk of SBO after appendectomy. Our findings confirmed that a laparoscopic approach is better than an open approach.
术后小肠梗阻（SBO）是阑尾切除术的常见并发症。本研究旨在评估阑尾切除术后发生SBO的危险因素。这项回顾性队列研究使用了2006年至2008年台湾国民健康保险研究数据库。我们评估了2006年1月1日至2008年12月31日期间接受开放阑尾切除术（OA）或腹腔镜阑尾切除术（LA）的成年急性阑尾炎患者。排除在本次手术前有腹部手术史和SBO病史的患者，或在阑尾切除术后与肠梗阻初步诊断之间进行腹部手术且该手术可确定为SBO病因的患者。重点关注了被认为会影响术后SBO的因素。OA组和LA组通过倾向评分进行匹配，并计算SBO的风险比（HR）和95%置信区间（CI）。
我们纳入了11289例行OA的患者以及11289例匹配的行LA的对照。与LA组相比，OA患者发生粘连性SBO的风险显著更高（校正HR：1.7，95%CI：1.11 - 2.63）。进一步分析显示，女性（校正HR：1.79，95%CI：1.17 - 2.72）、CCI评分为1或≥2（校正HR：3.16，95%CI：1.76 - 5.67；校正HR：4.03，95%CI：1.57 - 10.34）、复杂性阑尾炎（校正HR：1.68，95%CI：1.05 - 2.69）、在地区医院接受治疗会增加粘连性SBO的风险。
女性、复杂性阑尾炎、更多的合并症以及在地区医院接受治疗是阑尾切除术后发生SBO风险的相关因素。我们的研究结果证实，腹腔镜手术方式优于开放手术方式。
