Kim Jeong Yeon, Kim Jong Wan, Park Jun Ho, Kim Byung Chun, Yoon Sang Nam
Department of Surgery, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwasung, Korea.
Department of Surgery, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea.
Ann Surg Treat Res. 2019 Aug;97(2):103-111. doi: 10.4174/astr.2019.97.2.103. Epub 2019 Jul 29.
Surgeons may be uncertain about the optimal timing of appendectomy to decrease complications, especially for complicated appendicitis. The aim of the study was to compare clinical outcomes between early and late surgery for complicated appendicitis.
A prospectively maintained database of complicated appendicitis was queried. Elective interval surgery (EIS) group and early surgery (ES) were matched with propensity score and marked with a prefix 'p.' Patient characteristics and surgical outcomes were compared.
The propensity score-matched EIS group had a lower chance to underwent ileo-cecectomy or right hemicolectomy (1.5% . 6.9%, P = 0.031), a tendency of lower rate of postoperative complication (6.9% . 13.7%, P = 0.067), a lower rate of wound infection (1.5% . 8.4%, P = 0.010), and shorter postoperative hospital stay (3.72 days . 5.82 days, P < 0.001) than the propensity score-matched ES group. Multivariate analysis showed that delayed surgery for more than 48 hours or urgent surgery due to failure of EIS and open conversion were independent risk factors for postoperative complications (P = 0.001 and P = 0.025, respectively). In subgroup analysis, high American Society of Anesthesiologists physical status classification and distant abscess or generalized ascites in initial CT increased the risk of failure of EIS.
EIS can be a useful option for selected adult patients with complicated appendicitis.
外科医生对于阑尾切除术的最佳时机可能存在不确定性，以减少并发症，尤其是对于复杂性阑尾炎。本研究的目的是比较复杂性阑尾炎早期手术和晚期手术的临床结局。
查询前瞻性维护的复杂性阑尾炎数据库。将择期间隔手术（EIS）组和早期手术（ES）组进行倾向评分匹配，并以前缀“p.”标记。比较患者特征和手术结局。
倾向评分匹配的EIS组接受回盲部切除术或右半结肠切除术的机会较低（1.5%对6.9%，P = 0.031），术后并发症发生率有降低趋势（6.9%对13.7%，P = 0.067），伤口感染率较低（1.5%对8.4%，P = 0.010），术后住院时间较短（3.72天对5.82天，P < 0.001），优于倾向评分匹配的ES组。多因素分析显示，手术延迟超过48小时或因EIS失败及转为开放手术而进行的急诊手术是术后并发症的独立危险因素（分别为P = 0.001和P = 0.025）。在亚组分析中，美国麻醉医师协会身体状况分类较高以及初始CT显示远处脓肿或广泛腹水增加了EIS失败的风险。
对于选定的复杂性阑尾炎成年患者，EIS可能是一种有用的选择。
