Department of Surgery and Cancer, Imperial College London, London, UK.
Surg Endosc. 2020 May;34(5):2012-2018. doi: 10.1007/s00464-019-06980-y. Epub 2019 Aug 19.
Minimal access surgery (MAS) has suggested improvements in clinical outcomes compared to open surgery in several abdominal elective and emergency surgeries. The aims of this study were to compare England with the United States in the utilisation of MAS and mortality from four common abdominal surgical emergencies.
Between 2006 and 2012, the rate of MAS and in-hospital mortality for appendicitis, incarcerated or strangulated abdominal hernia, small or large bowel and peptic ulcer perforation were compared between England and the United States. Univariate and multivariate analyses were performed to adjust for differences in baseline patient demographics.
132,364 admissions in England were compared to an estimated 1,811,136 admissions in the United States. Minimal access surgery was used less commonly in England for appendicitis (odds ratio (OR) 0.27, 95% CI 0.267-0.278), abdominal hernia (OR 0.16, 95% CI 0.15-0.17), small or large bowel perforation (OR 0.33, 95% CI 0.32-0.35) and peptic ulcer perforation (OR 0.93, 95% CI 0.87-0.99). In-hospital mortality was increased in England compared to the United States for all four conditions: appendicitis (OR 2.11, 95% CI 1.66-2.68), abdominal hernia (OR 3.25, 95% CI 3.10-3.40), small or large bowel perforation (OR 3.88, 95% CI 3.76-3.99) and peptic ulcer perforation (OR 3.09, 95% CI 2.94-3.25). In England, after adjustment for patient demographics, open surgery was associated with increased in-hospital mortality for abdominal hernia (OR 1.80, 95% CI 1.26-2.71), small or large bowel perforation (OR 1.59, 95% CI 1.37-1.87) and peptic ulcer perforation (OR 2.31, 95% CI 1.91-2.82).
Minimal access surgery was performed less commonly and in-hospital mortality was increased in England compared to the United States for common abdominal surgical conditions. Therefore, strategies to enhance adoption of MAS in emergency conditions in England need to be optimised and include appropriate patient selection and improved surgeon MAS training.
微创外科（MAS）在一些腹部择期和急诊手术中，相较于开放性手术，在临床结局方面具有改善作用。本研究的目的是比较英格兰和美国在四种常见腹部外科急症中 MAS 的应用情况和死亡率。
在 2006 年至 2012 年间，对英格兰和美国的阑尾炎、嵌顿或绞窄性腹部疝、小肠或大肠穿孔和消化性溃疡穿孔的 MAS 率和院内死亡率进行了比较。采用单变量和多变量分析来调整基线患者人口统计学差异。
与美国估计的 1811136 例住院患者相比，英格兰有 132364 例住院患者。在阑尾炎（比值比[OR]0.27，95%可信区间[CI]0.267-0.278）、腹部疝（OR 0.16，95%CI 0.15-0.17）、小肠或大肠穿孔（OR 0.33，95%CI 0.32-0.35）和消化性溃疡穿孔（OR 0.93，95%CI 0.87-0.99）方面，英格兰较少使用 MAS。与美国相比，在所有四种情况下，英格兰的院内死亡率都有所升高：阑尾炎（OR 2.11，95%CI 1.66-2.68）、腹部疝（OR 3.25，95%CI 3.10-3.40）、小肠或大肠穿孔（OR 3.88，95%CI 3.76-3.99）和消化性溃疡穿孔（OR 3.09，95%CI 2.94-3.25）。在英格兰，根据患者人口统计学因素进行调整后，开放性手术与腹部疝（OR 1.80，95%CI 1.26-2.71）、小肠或大肠穿孔（OR 1.59，95%CI 1.37-1.87）和消化性溃疡穿孔（OR 2.31，95%CI 1.91-2.82）的院内死亡率增加相关。
与美国相比，在常见的腹部外科急症中，英格兰 MAS 的应用较少，院内死亡率更高。因此，需要优化在英格兰紧急情况下采用 MAS 的策略，包括合适的患者选择和提高外科医生 MAS 培训。
