Bailey Kate, Choynowski Michelle, Kabir Syed Mohammad Umar, Lawler Jack, Badrin Adibah, Sugrue Michael
Donegal Clinical and Research Academy, Letterkenny University Hospital, Letterkenny, Ireland.
Department of Surgery, Letterkenny University Hospital, Letterkenny, Ireland.
ANZ J Surg. 2019 Nov;89(11):1386-1391. doi: 10.1111/ans.15362. Epub 2019 Jul 30.
Appendicitis is the most common cause of acute abdominal pain requiring surgical intervention. While many studies report readmission, a meta-analysis of readmission post-appendectomy has not been published. This meta-analysis was undertaken to determine rates and predictors of hospital readmission following appendectomy and to potentially provide a metric benchmark.
An ethically approved PROSPERO-registered (ID CRD42017069040) meta-analysis following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, using databases PubMed and Scopus, was undertaken for studies published between January 2012 and June 2017. Articles relating to outcomes and readmissions after appendectomy were identified. Those scoring >15 for comparative studies and >10 for non-comparative studies, using Methodological Index for Non-Randomized Studies criteria were included in the final analysis. The odds ratios (OR) using random-effects, Mantel-Haenszel method with 95% confidence intervals (CI), were computed for each risk factor with RevMan5.
A total of 1757 articles reviewed were reduced to 45 qualifying studies for a final analysis of 836 921 appendectomies. 4.3% (range 0.0-14.4%) of patients were readmitted within 30 days. Significant preoperative patient factors for increased readmission were diabetes mellitus (OR 1.93, CI 1.63-2.28, P < 0.00001), complicated appendicitis (OR 3.6, CI 2.43-5.34, P < 0.00001) and open surgical technique (OR 1.39, CI 1.08-1.79, P < 0.00001). Increased readmission was not associated with gender, obesity or paediatric versus general surgeons or centres.
This meta-analysis identified that readmission is not uncommon post-appendectomy, occurring in one in 25 cases. The mean readmission rate of 4.3% may act as a quality benchmark for improving emergency surgical care. Targeting high-risk groups with diabetes or complicated appendicitis and increasing use of laparoscopic technique may help reduce readmission rates.
阑尾炎是需要手术干预的急性腹痛的最常见原因。虽然许多研究报告了再入院情况，但尚未发表关于阑尾切除术后再入院的荟萃分析。本荟萃分析旨在确定阑尾切除术后医院再入院率及预测因素，并有可能提供一个衡量基准。
按照系统评价和荟萃分析的首选报告项目指南，在伦理批准的PROSPERO注册（ID CRD42017069040）的荟萃分析中，使用PubMed和Scopus数据库，对2012年1月至2017年6月发表的研究进行分析。确定与阑尾切除术后结局和再入院相关的文章。根据非随机研究方法学指数标准，比较研究得分>15分、非比较研究得分>10分的文章纳入最终分析。使用RevMan5软件，采用随机效应的Mantel-Haenszel方法计算每个风险因素的比值比（OR）及95%置信区间（CI）。
共检索到1757篇文章，最终纳入45项合格研究，涉及836921例阑尾切除术。4.3%（范围0.0 - 14.4%）的患者在30天内再次入院。术前导致再入院率增加的显著患者因素包括糖尿病（OR 1.93，CI 1.63 - 2.28，P < 0.00001）、复杂性阑尾炎（OR 3.6，CI 2.43 - 5.34，P < 0.00001）和开放手术技术（OR 1.39，CI 1.08 - 1.79，P < 0.00001）。再入院率增加与性别、肥胖、小儿外科医生与普通外科医生或不同中心无关。
本荟萃分析表明，阑尾切除术后再入院并不罕见，每25例中就有1例发生。4.3%的平均再入院率可作为改善急诊手术护理的质量基准。针对糖尿病或复杂性阑尾炎等高危人群，并增加腹腔镜技术的使用，可能有助于降低再入院率。
