Saluja Saurabh, Sun Tianyi, Mao Jialin, Steigman Shaun A, Oh P Stephen, Yeo Heather L, Sedrakyan Art, Merianos Demetri J
Department of Surgery, Weill Cornell Medicine, 1300 York Ave., New York, NY 10065, USA.
Department of Healthcare Policy and Research, Weill Cornell Medicine, 402 East 67th Street, New York, NY 10065, USA.
J Pediatr Surg. 2018 Jul;53(7):1339-1344. doi: 10.1016/j.jpedsurg.2017.09.012. Epub 2017 Oct 2.
Complicated appendicitis is common in children, yet the timing of surgical management remains controversial. Some support initial antibiotics with delayed operation whereas others support immediate operation. While a few randomized trials have evaluated this question, they have been small, single-center trials with limited follow-up. We present a database analysis of outcomes in early versus late surgical management of complicated appendicitis with one-year follow-up.
We conducted a retrospective review of children with complicated appendicitis presenting between 2000 and 2013, utilizing a New York State database. We compare children undergoing later versus early appendectomy with a primary outcome measure of any complication within one year as determined from ICD-9 codes.
8840 children were included in the analysis, 7708 of whom underwent early appendectomy. Patients with late appendectomy were significantly more likely to have at least one complication when compared to those undergoing early appendectomy (34.6% vs 26.7%, p<0.01).
We present the first population-level study evaluating early versus late appendectomy in children with complicated appendicitis with a one-year follow-up period. Children undergoing late appendectomy were more likely to have a complication than those undergoing early appendectomy. These data corroborated previous studies supporting early operative management.
This study provides level III evidence of a treatment study.
复杂性阑尾炎在儿童中很常见，但手术治疗的时机仍存在争议。一些人支持先使用抗生素并延迟手术，而另一些人则支持立即手术。虽然有一些随机试验评估了这个问题，但它们都是小型的单中心试验，随访有限。我们对复杂性阑尾炎早期与晚期手术治疗的结果进行了数据库分析，并进行了一年的随访。
我们利用纽约州的一个数据库，对2000年至2013年间出现复杂性阑尾炎的儿童进行了回顾性研究。我们比较了接受晚期与早期阑尾切除术的儿童，主要结局指标是根据国际疾病分类第九版（ICD-9）编码确定的一年内的任何并发症。
8840名儿童纳入分析，其中7708名接受了早期阑尾切除术。与接受早期阑尾切除术的患者相比，接受晚期阑尾切除术的患者发生至少一种并发症的可能性显著更高（34.6%对26.7%，p<0.01）。
我们首次进行了一项基于人群的研究，评估复杂性阑尾炎儿童早期与晚期阑尾切除术，并进行了一年的随访。接受晚期阑尾切除术的儿童比接受早期阑尾切除术的儿童更容易出现并发症。这些数据证实了先前支持早期手术治疗的研究。
本研究提供了一项治疗研究的III级证据。
