Al-Khyatt Waleed, Mytton Jemma, Tan Benjamin H L, Aquina Christopher T, Evison Felicity, Fleming Fergal J, Pasquali Sandro, Griffiths Ewen A, Vohra Ravinder S
Trent Oesophago-Gastric Unit, Nottingham University Hospitals NHS Trust, City Hospital Campus, Hucknall Road, Nottingham, NG5 1PB, UK.
Department of Health Informatics, University Hospitals Birmingham NHS Foundation Trust, Yardley Court, 11-13 Frederick Road, Edgbaston, Birmingham, B15 1JD, UK.
World J Surg. 2017 Aug;41(8):1975-1984. doi: 10.1007/s00268-017-3981-z.
To compare selected outcomes (30-day reoperation and total length of hospital stay) following emergency appendectomy between populations from New York State and England.
This retrospective cohort study used demographic and in-hospital outcome data from Hospital Episode Statistics (HES) and the New York Statewide Planning and Research Cooperative System (SPARCS) administrative databases for all patients aged 18+ years undergoing appendectomy between April 2009 and March 2014. Univariate and adjusted multivariable logistic regression were used to test significant factors. A one-to-one propensity score matched dataset was created to compare odd ratios (OR) of reoperations between the two populations.
A total of 188,418 patient records, 121,428 (64.4%) from England and 66,990 (35.6%) from NYS, were extracted. Appendectomy was completed laparoscopically in 77.7% of patients in New York State compared to 53.6% in England (P < 0.001). The median lengths of hospital stay for patients undergoing appendectomy were 3 (interquartile range, IQR 2-4) days versus 2 (IQR 1-3) days (P < 0.001) in England and New York State, respectively. All 30-day reoperation rates were higher in England compared to New York State (1.2 vs. 0.6%, P < 0.001), representing nearly a twofold higher risk of 30-day reoperation (OR 1.88, 95% CI 1.64-2.14, P < 0.001). As the proportion of appendectomy completed laparoscopically increased, there was a reduction in the reoperation rate in England (correlation coefficient -0.170, P = 0.036).
Reoperations and total length of hospital stay is significantly higher following appendectomy in England compared to New York State. Increasing the numbers of appendectomy completed laparoscopically may decrease length of stay and reoperations.
比较纽约州和英格兰人群急诊阑尾切除术后的特定结局（30天再次手术和住院总时长）。
这项回顾性队列研究使用了医院事件统计（HES）和纽约州全州规划与研究合作系统（SPARCS）行政数据库中的人口统计学和住院结局数据，纳入了2009年4月至2014年3月期间所有接受阑尾切除术的18岁及以上患者。采用单因素和校正多因素逻辑回归分析来检验显著因素。创建了一个一对一倾向评分匹配数据集，以比较两个人群再次手术的比值比（OR）。
共提取了188,418份患者记录，其中121,428份（64.4%）来自英格兰，66,990份（35.6%）来自纽约州。纽约州77.7%的患者通过腹腔镜完成阑尾切除术，而英格兰这一比例为53.6%（P < 0.001）。在英格兰和纽约州，接受阑尾切除术患者的住院中位时长分别为3天（四分位间距，IQR 2 - 4）和2天（IQR 1 - 3）（P < 0.001）。英格兰的所有30天再次手术率均高于纽约州（1.2%对0.6%，P < 0.001），这表明30天再次手术的风险几乎高出两倍（OR 1.88，95% CI 1.64 - 2.14，P < 0.001）。随着腹腔镜阑尾切除术完成比例的增加，英格兰的再次手术率有所降低（相关系数 -0.170，P = 0.036）。
与纽约州相比，英格兰阑尾切除术后的再次手术率和住院总时长显著更高。增加腹腔镜阑尾切除术的数量可能会减少住院时长和再次手术率。
