医院类型对青少年急性阑尾炎治疗的影响。

Effect of hospital type on the treatment of acute appendicitis in teenagers.

作者信息

Litz Cristen N, Ciesla David J, Danielson Paul D, Chandler Nicole M

机构信息

Johns Hopkins All, Children's Hospital, Outpatient Care Center, 601 5(th) Street South, Dept 70-6600, 3(rd) Floor, Saint Petersburg, FL 33701.

University of South Florida, Morsani College of Medicine, 1 Tampa General Circle, G417, Tampa, FL 33606.

出版信息

J Pediatr Surg. 2018 Mar;53(3):446-448. doi: 10.1016/j.jpedsurg.2017.03.062. Epub 2017 Apr 5.

DOI:10.1016/j.jpedsurg.2017.03.062

PMID:28408075

Abstract

BACKGROUND

Teenagers receive appendicitis care at both adult and pediatric facilities. The purpose of this study was to evaluate outcomes following treatment of acute appendicitis in teenagers based on the type of hospital facility.

METHODS

Patients aged 13-17years with acute appendicitis who were discharged from acute care hospitals from 2009 to 2014 were identified using a statewide discharge dataset. Hospitals were classified as pediatric or adult and outcomes were compared.

RESULTS

There were 5585 patients treated in adult hospitals and 1625 in pediatric hospitals. Fewer patients at adult hospitals had complicated appendicitis (20.4% vs. 33.0%, p<0.01). Open appendectomy occurred more often in adult hospitals compared to pediatric hospitals (12.6% vs. 6.0%, p<0.01). Pediatric hospitals had higher rates of non-operative management (10% vs. 3.4%, p<0.01) and percutaneous drain placement (1.2% vs. 0.4%, p<0.01). Postoperative complication rates did not significantly differ between hospital types.

CONCLUSION

Most teenagers undergo appendectomy at adult facilities; however, a greater proportion of younger patients and patients with complicated appendicitis is treated at pediatric hospitals. Treatment at a freestanding children's hospital results in lower rates of open procedures and no difference in complications. Opportunities may exist to standardize care across treating facilities to optimize outcomes and resource use.

TYPE OF STUDY

Prognosis study.

LEVEL OF EVIDENCE

II.

摘要

背景

青少年在成人和儿科医疗机构接受阑尾炎治疗。本研究的目的是根据医院设施类型评估青少年急性阑尾炎治疗后的结果。

方法

利用全州出院数据集，确定2009年至2014年从急症医院出院的13至17岁急性阑尾炎患者。医院分为儿科或成人医院，并比较结果。

结果

成人医院治疗了5585例患者，儿科医院治疗了1625例患者。成人医院并发阑尾炎的患者较少（20.4%对33.0%，p<0.01）。与儿科医院相比，成人医院开放性阑尾切除术的发生率更高（12.6%对6.0%，p<0.01）。儿科医院的非手术治疗率（10%对3.4%，p<0.01）和经皮引流放置率（1.2%对0.4%，p<0.01）更高。不同医院类型的术后并发症发生率无显著差异。