Pedziwiatr Michal, Lasek Anna, Wysocki Michal, Mavrikis Judene, Mysliwiec Piotr, Bobowicz Maciej, Karcz Wojciech, Michalik Maciej, Makarewicz Wojciech, Major Piotr, Rubinkiewicz Mateusz, Stefura Tomasz, Kenig Jakub, Polanska-Plachta Malgorzata, Polish Laparoscopic Appendectomy Pol-LA
2nd Department of General Surgery, Jagiellonian University Medical College, Kraków-Poland.
Center for Research, Training and Innovation in Surgery (CERTAIN Surgery), Kraków-Poland.
Ulus Travma Acil Cerrahi Derg. 2019 Mar;25(2):129-136. doi: 10.5505/tjtes.2018.80103.
Preoperative classification of complicated and uncomplicated appendicitis (AA) is challenging. However, the differences in surgical outcomes necessitate the establishment of risk factors in developing, complicated AA. This study was an analysis of the clinical outcomes of laparoscopic appendectomies (LA), as well as preoperative risk factors for the development of complicated AA.
The data of 618 patients who underwent LA in 18 surgical units across Poland and Germany were collected in an online web-based database created by the Polish Videosurgery Society. The surgical outcomes of patients with complicated and uncomplicated appendicitis were compared. Uni- and multivariate logistic regression models were used to establish risk factors for the development of complicated appendicitis.
In all, 1269 (27.5%) patients underwent LA for complicated appendicitis (Group 1) and 3349 (72.5%) for uncomplicated appendicitis (Group 2). The conversion rate, number of intra-operative adverse events, re-intervention rate, postoperative complications, and readmission rate was greater in Group 1. The preoperative risk factors associated with complicated appendicitis were: female sex (Odds ratio [OR]: 1.58), obesity (OR: 1.51), age >50 years (OR: 1.51), symptoms >48 hours (OR: 2.18), high Alvarado score (OR: 1.29 with every point), and C-reactive protein level >100 mg/L (OR: 3.92).
Several demographic and clinical risk factors for complicated AA were identified. LA for complicated appendicitis was associated with poorer outcomes.
复杂型和非复杂型阑尾炎（AA）的术前分类具有挑战性。然而，手术结果的差异使得有必要确定复杂型AA发生发展的风险因素。本研究分析了腹腔镜阑尾切除术（LA）的临床结果以及复杂型AA发生发展的术前风险因素。
在波兰视频外科学会创建的在线网络数据库中收集了波兰和德国18个手术科室618例行LA患者的数据。比较了复杂型和非复杂型阑尾炎患者的手术结果。采用单因素和多因素逻辑回归模型确定复杂型阑尾炎发生发展的风险因素。
共有1269例（27.5%）患者因复杂型阑尾炎接受LA（第1组），3349例（72.5%）因非复杂型阑尾炎接受LA（第2组）。第1组的中转率、术中不良事件数量、再次干预率、术后并发症和再入院率更高。与复杂型阑尾炎相关的术前风险因素包括：女性（比值比[OR]：1.58）、肥胖（OR：1.51）、年龄>50岁（OR：1.51）、症状持续>48小时（OR：2.18）、高阿尔瓦拉多评分（每增加1分OR：1.29）以及C反应蛋白水平>100 mg/L（OR：3.92）。
确定了复杂型AA的一些人口统计学和临床风险因素。复杂型阑尾炎的LA与较差的手术结果相关。
