Almström Markus, Svensson Jan F, Patkova Barbora, Svenningsson Anna, Wester Tomas
*Department of Pediatric Surgery, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden †Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden ‡Department of Surgery, Västmanland's Hospital Västerås, Västerås, Sweden.
Ann Surg. 2017 Mar;265(3):616-621. doi: 10.1097/SLA.0000000000001694.
To investigate the correlation between in-hospital surgical delay before appendectomy for suspected appendicitis and the finding of perforated appendicitis in children.
All children undergoing acute appendectomy for suspected acute appendicitis at Karolinska University Hospital, Stockholm, Sweden from 2006 to 2013 were reviewed for the exposure of surgical delay. Primary endpoint was the histopathologic finding of perforated appendicitis. The main explanatory variable was in-hospital surgical delay, using surgery within 12 hours as reference. Secondary endpoints were postoperative wound infection, intra-abdominal abscess, reoperation, length of hospital stay, and readmission. To adjust for selection bias, a logistic regression model was created to estimate odds ratios for the main outcome measures. Missing data were replaced using multiple imputation.
The study comprised 2756 children operated for acute appendicitis. Six hundred sixty-one (24.0%) had a histopathologic diagnosis of perforated appendicitis. In the multivariate logistic regression analysis, increased time to surgery was not associated with increased risk of histopathologic perforation. There was no association between the timing of surgery and postoperative wound infection, intra-abdominal abscess, reoperation, or readmission.
In-hospital delay of acute appendectomy in children was not associated with an increased rate of histopathologic perforation. Timing of surgery was not an independent risk factor for postoperative complications. The results were not dependent on the magnitude of the surgical delay. The findings are analogous with previous findings in adults and may aid the utilization of available hospital- and operative resources.
探讨疑似阑尾炎患儿阑尾切除术前住院手术延迟与阑尾穿孔病理结果之间的相关性。
回顾性分析2006年至2013年在瑞典斯德哥尔摩卡罗林斯卡大学医院因疑似急性阑尾炎接受急性阑尾切除术的所有患儿的手术延迟情况。主要终点是阑尾穿孔的组织病理学结果。主要解释变量是住院手术延迟，以12小时内手术作为参照。次要终点包括术后伤口感染、腹腔内脓肿、再次手术、住院时间和再入院情况。为校正选择偏倚，建立逻辑回归模型以估计主要结局指标的比值比。采用多重填补法替代缺失数据。
该研究纳入了2756例接受急性阑尾炎手术的患儿。661例（24.0%）有阑尾穿孔的组织病理学诊断。在多因素逻辑回归分析中，手术时间延长与组织病理学穿孔风险增加无关。手术时机与术后伤口感染、腹腔内脓肿再次手术或再入院之间无关联。
儿童急性阑尾切除术中的住院延迟与组织病理学穿孔率增加无关。手术时机不是术后并发症的独立危险因素。结果不依赖于手术延迟的时长。这些发现与既往在成人中的发现相似，可能有助于医院和手术资源的合理利用。
