Andert Anne, Alizai H P, Klink C D, Neitzke N, Fitzner C, Heidenhain C, Kroh A, Neumann U P, Binnebösel M
Department of General, Visceral and Transplant Surgery, Uniklinik RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany.
Department of Medical Statistics, Uniklinik RWTH Aachen, Aachen, Germany.
Langenbecks Arch Surg. 2017 Sep;402(6):987-993. doi: 10.1007/s00423-017-1608-3. Epub 2017 Jul 27.
The aim of the present study was to evaluate the risk factors for postoperative complications after an appendectomy with special regard to both the time period from hospital admission to operation and night time surgery.
Patients who underwent an appendectomy due to acute appendicitis and were admitted to the University Hospital Aachen between January 2003 and January 2014 were included in this retrospective analysis. Regarding the occurrence of postoperative complications, patients were divided into the following two groups: the group with complications (group 1) and the group without complications (group 2).
Of the 2136 patients who were included in this study, 165 patients (group 1) exhibited complications, and in 1971 patients (group 2), no complications appeared. After a univariate logistic regression analysis, six predictors for postoperative complications were found and are described as follows: (1) complicated appendicitis (odds ratio (OR) 4.8 (3.46-6.66), p < 0.001), (2) operation at night (OR 1.62 (1.17-2.24), p = 0.004), (3) conversion from laparoscopic to open access (OR 37.08 (12.95-106.17), p < 0.001), (4) an age > 70 years (OR 6.00 (3.64-9.89), p < 0.001), (5) elevated CRP (OR 1.01 (1.01-1.01), p < 0.001) and (6) increased WBC count (OR 1.04 (1.01-1.07), p = 0.003). After multivariate logistic regression analysis, a significant association was demonstrated for complicated appendicitis (1.88 (1.06-3.32), p < 0.031), conversion to open access (OR 16.33 (4.52-58.98), p < 0.001), elevated CRP (OR 1.00 (1.00-1.01), p = 0.017) and an age > 70 years (OR 3.91 (2.12-7.21), p < 0.001). The time interval between hospital admission and operation was not associated with postoperative complications in the univariate and multivariate logistic regression analyses, respectively. However, the interaction between complicated appendicitis and the time interval to operation was significant (OR 1.024 (1.00-1.05), p = 0.028).
Based on our findings, surgical delay in the case of appendicitis and operation at night did not increase the risk for postoperative complications. However, the mean waiting time was less than 12 h and patients aged 70 years or older were at a higher risk for postoperative complications. Furthermore, for the subgroup of patients with complicated appendicitis, the time interval to surgery had a significant influence on the occurrence of postoperative complications. Therefore, the contemporary operation depending on the clinical symptoms and patient age remains our recommendation.
本研究的目的是评估阑尾切除术后并发症的危险因素，特别关注从入院到手术的时间段以及夜间手术。
纳入2003年1月至2014年1月期间因急性阑尾炎在亚琛大学医院接受阑尾切除术的患者进行回顾性分析。根据术后并发症的发生情况，将患者分为以下两组：有并发症组（第1组）和无并发症组（第2组）。
本研究纳入的2136例患者中，165例（第1组）出现并发症，1971例（第2组）未出现并发症。单因素逻辑回归分析后，发现术后并发症的六个预测因素如下：（1）复杂性阑尾炎（比值比（OR）4.8（3.46 - 6.66），p < 0.001），（2）夜间手术（OR 1.62（1.17 - 2.24），p = 0.004），（3）从腹腔镜手术转为开放手术（OR 37.08（12.95 - 106.17），p < 0.001），（4）年龄>70岁（OR 6.00（3.64 - 9.89），p < 0.001），（5）CRP升高（OR 1.01（1.01 - 1.01），p < 0.001）和（6）白细胞计数增加（OR 1.04（1.01 - 1.07），p = 0.003）。多因素逻辑回归分析后，发现复杂性阑尾炎（1.88（1.06 - 3.32），p < 0.031）、转为开放手术（OR 16.33（4.52 - 58.98），p < 0.001）、CRP升高（OR 1.00（1.00 - 1.01），p = 0.017）和年龄>70岁（OR 3.91（2.12 - 7.21），p < 0.001）之间存在显著关联。在单因素和多因素逻辑回归分析中，入院至手术的时间间隔与术后并发症均无关联。然而，复杂性阑尾炎与手术时间间隔之间的交互作用显著（OR 1.024（1.00 - 1.05），p = 0.028）。
根据我们的研究结果，阑尾炎手术延迟和夜间手术并未增加术后并发症的风险。然而，平均等待时间少于12小时，70岁及以上患者术后并发症风险较高。此外，对于复杂性阑尾炎患者亚组，手术时间间隔对术后并发症的发生有显著影响。因此，根据临床症状和患者年龄进行适时手术仍是我们的建议。
