Menzies Centre for Health Policy, University of Sydney, Sydney, NSW
Sydney Children's Hospital, Sydney, NSW.
Med J Aust. 2018 Jul 16;209(2):80-85. doi: 10.5694/mja17.00541. Epub 2018 Jul 9.
To assess and compare the post-operative outcomes of open and laparoscopic appendicectomy in children.
Record linkage analysis of administrative hospital (Admitted Patient Data Collection) and emergency department (Emergency Department Data Collection) data.Participants, setting: Children under 16 years of age who underwent an appendicectomy in a public or private hospital in New South Wales between January 2002 and December 2013.
Association between type of appendicectomy and post-operative complications within 28 days of discharge, adjusted for patient characteristics and type of hospital.
Of 23 961 children who underwent appendicectomy, 19 336 (81%) had uncomplicated appendicitis and 4625 (19%) had appendicitis complicated by abscess, perforation, or peritonitis. The proportion of laparoscopic appendicectomies increased from 11.8% in 2002 to 85.8% in 2013. In cases of uncomplicated appendicitis, laparoscopic appendicectomy was associated with more post-operative complications (mostly symptomatic re-admissions or emergency department presentations) than open appendicectomy (7.4% v 5.8%), but with a reduced risk of post-operative intestinal obstruction (adjusted odds ratio [aOR], 0.59; 95% CI, 0.36-0.97). For cases of complicated appendicitis, the risk of wound infections was lower for laparoscopic appendicectomy (aOR, 0.67; 95% CI, 0.50-0.90), but not the risks of intestinal obstruction (aOR, 0.97; 95% CI, 0.62-1.52) or intra-abdominal abscess (aOR, 1.06; 95% CI, 0.72-1.55).
Post-appendicectomy outcomes were similar for most age groups and hospital types. Children with uncomplicated appendicitis have lower risk of post-operative bowel obstruction after laparoscopic appendicectomy than after open appendicectomy, but may be discharged before their post-operative symptoms have adequately resolved.
评估和比较儿童开腹和腹腔镜阑尾切除术的术后结果。
对医院行政（住院患者数据采集）和急诊科（急诊科数据采集）数据进行记录链接分析。
参与者，地点：2002 年 1 月至 2013 年 12 月期间在新南威尔士州的公立医院或私立医院接受阑尾切除术的 16 岁以下儿童。
调整患者特征和医院类型后，阑尾切除术类型与出院后 28 天内术后并发症之间的关联。
在 23961 例接受阑尾切除术的儿童中，19336 例（81%）为单纯性阑尾炎，4625 例（19%）为阑尾脓肿、穿孔或腹膜炎。腹腔镜阑尾切除术的比例从 2002 年的 11.8%增加到 2013 年的 85.8%。在单纯性阑尾炎病例中，腹腔镜阑尾切除术比开腹阑尾切除术更易发生术后并发症（主要为症状性再入院或急诊就诊）（7.4%比 5.8%），但术后肠梗阻的风险降低（调整后比值比[aOR]，0.59；95%CI，0.36-0.97）。对于复杂性阑尾炎病例，腹腔镜阑尾切除术的伤口感染风险较低（aOR，0.67；95%CI，0.50-0.90），但肠梗阻（aOR，0.97；95%CI，0.62-1.52）、腹腔脓肿（aOR，1.06；95%CI，0.72-1.55）的风险无差异。
对于大多数年龄组和医院类型，阑尾切除术后的结果相似。对于单纯性阑尾炎患儿，腹腔镜阑尾切除术比开腹阑尾切除术术后发生肠粘连的风险更低，但可能在术后症状尚未完全缓解时出院。
