Department of Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 5.256, Houston, TX 77030, United States; Center for Surgical Trials and Evidence-based Practice (C-STEP), McGovern Medical School at the University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 5.256, Houston, TX 77030, United States; Children's Memorial Hermann Hospital, 6411 Fannin Street, Houston, TX 77030, United States.
Department of Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 5.256, Houston, TX 77030, United States; Center for Surgical Trials and Evidence-based Practice (C-STEP), McGovern Medical School at the University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 5.256, Houston, TX 77030, United States; Children's Memorial Hermann Hospital, 6411 Fannin Street, Houston, TX 77030, United States.
J Pediatr Surg. 2021 Apr;56(4):727-732. doi: 10.1016/j.jpedsurg.2020.06.031. Epub 2020 Jun 27.
BACKGROUND/PURPOSE: Prophylactic, intraabdominal drains have been used to prevent intraabdominal abscess (IAA) after perforated appendicitis. We hypothesized that routine drain placement would reduce the IAA rate in pediatric perforated appendicitis.
A 27-month quality improvement (QI) initiative was conducted: closed-suction, intraabdominal drains were placed intraoperatively in pediatric (age < 18) perforated appendicitis patients. QI patients were compared to controls admitted during the preceding 8 months and following 4 months. The primary outcome was 30-day IAA rate. Univariate and multivariate analyses were performed.
Two hundred seventy QI patients were compared to 109 controls. There was 100% compliance during 21 of 27 months of the QI initiative; only 7 QI patients did not receive drains. IAA occurred in 20.0% of QI patients and 22.9% of control (p = 0.52). After adjustment, the QI initiative was not associated with reduced odds of IAA (OR 0.83, 95% CI 0.48-1.44). Median length of stay was longer in QI patients during the index admission (p = 0.03) and over 30 postoperative days (p = 0.03), but these relationships did not persist after adjustment.
A QI initiative investigating prophylactic, intraabdominal drain placement in perforated appendicitis did not reduce the IAA rate. We recommend against routine drain placement in pediatric perforated appendicitis.
Level III.
背景/目的：预防性腹腔引流已被用于预防穿孔性阑尾炎术后腹腔脓肿（IAA）。我们假设常规引流放置将降低小儿穿孔性阑尾炎的 IAA 发生率。
进行了为期 27 个月的质量改进（QI）计划：在小儿（年龄<18 岁）穿孔性阑尾炎患者中，术中放置封闭式负压引流。QI 患者与之前 8 个月和之后 4 个月入院的对照进行比较。主要结果是 30 天 IAA 发生率。进行了单变量和多变量分析。
比较了 270 例 QI 患者和 109 例对照。在 QI 计划的 27 个月中的 21 个月，100%符合规范；只有 7 例 QI 患者未接受引流。QI 患者的 IAA 发生率为 20.0%，对照组为 22.9%（p=0.52）。调整后，QI 计划与 IAA 发生的几率降低无关（OR 0.83，95%CI 0.48-1.44）。QI 患者的住院时间在指数住院期间（p=0.03）和术后 30 天以上（p=0.03）均较长，但调整后这些关系并未持续。
一项针对穿孔性阑尾炎预防性腹腔引流放置的 QI 计划并未降低 IAA 发生率。我们建议不要在小儿穿孔性阑尾炎中常规放置引流管。
III 级。
