影像学利用对阑尾炎的阴性阑尾切除率的影响：一项 ACS-NSQIP 研究。
Imaging utilization affects negative appendectomy rates in appendicitis: An ACS-NSQIP study.
机构信息
Cedars-Sinai Medical Center, Department of Surgery, Los Angeles, CA, USA.
Cedars-Sinai Medical Center, Department of Surgery, Los Angeles, CA, USA.
出版信息
Am J Surg. 2019 Jun;217(6):1094-1098. doi: 10.1016/j.amjsurg.2018.12.072. Epub 2019 Jan 3.
BACKGROUND
Negative appendectomy rates (NAR) historically ranged from 15 to 25%, but have decreased recently.
METHODS
Using the 2016 ACS-NSQIP database, we identified patients who underwent appendectomies for appendicitis. Patients with and without appendicitis on pathology were compared. Multivariate analysis was used to identify predictors of negative appendectomies.
RESULTS
11,841 patients underwent appendectomies, with a NAR of 4.5%. Utilization rates of US, CT and MRI were 14.9%, 86.1%, and 1.1%. NAR's of US, CT, and MRI were 9.7%, 2.5%, and 7.1%, and 19.2% for patients without imaging. An ultrasound consistent with appendicitis has a NAR of 4.8%; adding a CT decreases it to 0.6%. Predictors of NA include females, smoking, no imaging, and ultrasounds. Factors with lower odds of NA include leukocytosis, sepsis, and CTs.
CONCLUSIONS
The NAR in the 2016 ACS-NSQIP population is 4.5%. CTs are the most frequently used imaging modality and have the lowest NAR. Obtaining a CT in addition to an ultrasound is associated with lower NAR. This should be further explored with a cost-benefit analysis between multiple imaging studies versus negative appendectomies.
背景
历史上，阴性阑尾切除术率（NAR）范围为 15%至 25%，但最近有所下降。
方法
我们使用 2016 年 ACS-NSQIP 数据库，确定了因阑尾炎而行阑尾切除术的患者。比较了病理上有和没有阑尾炎的患者。采用多变量分析来确定阴性阑尾切除术的预测因素。
结果
11841 例患者接受了阑尾切除术，NAR 为 4.5%。超声、CT 和 MRI 的使用率分别为 14.9%、86.1%和 1.1%。超声、CT 和 MRI 的 NAR 分别为 9.7%、2.5%和 7.1%，无影像学检查的 NAR 为 19.2%。与阑尾炎相符的超声检查 NAR 为 4.8%；加做 CT 可将其降至 0.6%。NAR 的预测因素包括女性、吸烟、无影像学检查和超声检查。NAR 较低的因素包括白细胞增多、脓毒症和 CT。
结论
2016 年 ACS-NSQIP 人群的 NAR 为 4.5%。CT 是最常用的影像学检查方法，其 NAR 最低。在超声检查的基础上加做 CT 与较低的 NAR 相关。这应该通过对多项影像学检查与阴性阑尾切除术之间的成本效益分析进一步探讨。
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