Gomes Carlos Augusto, Abu-Zidan Fikri M, Sartelli Massimo, Coccolini Federico, Ansaloni Luca, Baiocchi Gian Luca, Kluger Yoram, Di Saverio Salomone, Catena Fausto
Surgery Department, Faculdade de Ciências Médicas e da Saúde Juiz de Fora (SUPREMA), Hospital Universitário Therezinha de Jesus, Juiz de Fora, Brazil.
Department of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates.
World J Surg. 2018 Dec;42(12):3903-3910. doi: 10.1007/s00268-018-4736-1.
Our aim is to compare the management approaches and clinical outcomes of acute appendicitis according to annual Gross National Income per Capita (GNI/Capita) of countries.
Consecutive patients who were diagnosed to have acute appendicitis from 116 centers of 44 countries were prospectively studied over a 6-month period (April-September 2016). Studied variables included demography, Alvarado score, comorbidities, radiological and surgical management, histopathology, and clinical outcome. Data were divided into three groups depending on the GNI/Capita.
A total of 4271 patients having a mean (SD) age of 33.4 (17.3) years were studied. Fifty-five percent were males. Two hundred and eighty patients were from lower-middle-income (LMI) countries, 1756 were from upper-middle-income (UMI) countries, and 2235 were from high-income (HI) countries. Patients in LMI countries were significantly younger (p < 0.0001) and included more males (p < 0.0001). CT scan was done in less than 8% of cases in LMI countries, 23% in UMI countries, and 38% in HI countries. Laparoscopy was performed in 73% of the cases in the HI countries, while open appendectomy was done in more than 60% of cases in both LMI and UMI countries (p < 0.0001). The longest mean hospital stay was in the UMI group (4.84 days). There was no significant difference in the complication or death rates between the three groups. The overall death rate was 3 per 1000 patients.
There is great variation in the presentation, severity of disease, radiological workup, and surgical management of patients having acute appendicitis that is related to country income. A global effort is needed to address this variation. Individual socioeconomic status could be more important than global country socioeconomic status in predicting clinical outcome.
我们的目的是根据各国人均国民总收入（GNI/人均）比较急性阑尾炎的管理方法和临床结果。
对来自44个国家116个中心的连续诊断为急性阑尾炎的患者进行了为期6个月（2016年4月至9月）的前瞻性研究。研究变量包括人口统计学、阿尔瓦拉多评分、合并症、放射学和手术管理、组织病理学以及临床结果。根据GNI/人均将数据分为三组。
共研究了4271例患者，平均（标准差）年龄为33.4（17.3）岁。55%为男性。280例患者来自中低收入（LMI）国家，1756例来自中高收入（UMI）国家，2235例来自高收入（HI）国家。LMI国家的患者明显更年轻（p<0.0001），男性比例更高（p<0.0001）。LMI国家不到8%的病例进行了CT扫描，UMI国家为23%，HI国家为38%。HI国家73%的病例进行了腹腔镜手术，而LMI和UMI国家超过60%的病例进行了开放性阑尾切除术（p<0.0001）。平均住院时间最长的是UMI组（4.84天）。三组之间的并发症或死亡率没有显著差异。总体死亡率为每1000例患者3例。
急性阑尾炎患者在表现、疾病严重程度、放射学检查和手术管理方面存在很大差异，这与国家收入有关。需要全球共同努力来解决这种差异。在预测临床结果方面，个人社会经济地位可能比全球国家社会经济地位更重要。
