Department of General and Digestive Surgery, Hospital Universitario Doctor Peset, Avenida Gaspar Aguilar 90, 46017, Valencia, Spain.
Department of General and Digestive Surgery, Hospital Universitario de Marqués de Valdecilla, Santander, Spain.
Surg Endosc. 2021 Jul;35(7):3628-3635. doi: 10.1007/s00464-020-07841-9. Epub 2020 Aug 7.
Appendicitis-related hospitalizations linked with peritonitis or postoperative complications result in longer lengths of stay and higher costs. The aim of the present study was to assess the independent association between potential predictors and prolonged hospitalization after laparoscopic appendectomy (LA) for complicated acute appendicitis (CAA).
A retrospective cohort study was conducted on adult patients diagnosed with CAA in which LA was attempted. The primary outcome was a prolonged length of stay (LOS) after surgery, defined as hospitalizations longer than or equal to the 75th percentile for LOS, including the day of discharge. Hierarchical regression models were run to elucidate the independent predictors for the variable of interest.
The present study involved 160 patients with a mean age of 50.71 years. The conversion rate was 1.9%, and the overall postoperative morbidity rate was 23.8%. The median length of stay (LOS) was 5 days (75th percentile: 7 days). Multivariate analyses included nine variables that are statistically and/or clinically relevant to assess its relationship with a prolonged LOS: three preoperative (age, sex, and comorbidity), four intraoperative (appendix gangrene, perforation, degree of peritonitis, and drain placement), and two postoperative (immediate ICU admission and complications). The development of postoperative complications (OR 6.162, 95% CI 2.451-15.493; p = 0.000) and the placement of an abdominal drain (OR 3.438, 95% CI 1.107-10.683; p = 0.033) were found to be independent predictors for prolonged LOS. For patients not presenting postoperative complications, drain placement was the only independent predictor for the outcome (OR 7.853, 95% CI 1.520-40.558; p = 0.014). Sensitivity analyses showed confirmatory results.
The intraoperative process of care has a clear impact on LOS after LA for CAA in adults; therefore, the decision of whether to drain in these situations should be made more restrictively yet with judicious caution.
与腹膜炎或术后并发症相关的阑尾炎住院会导致住院时间延长和费用增加。本研究的目的是评估潜在预测因素与复杂性急性阑尾炎（CAA）行腹腔镜阑尾切除术（LA）后住院时间延长的独立相关性。
对尝试行 LA 治疗的成人 CAA 患者进行回顾性队列研究。主要结局是手术后的住院时间延长（LOS），定义为住院时间长于或等于 LOS 的第 75 百分位数，包括出院当天。使用分层回归模型阐明对感兴趣变量的独立预测因素。
本研究共纳入 160 例平均年龄为 50.71 岁的患者。转化率为 1.9%，总体术后发病率为 23.8%。中位 LOS 为 5 天（75 百分位数：7 天）。多变量分析包括 9 个与评估其与 LOS 延长相关的具有统计学和/或临床意义的变量：3 个术前变量（年龄、性别和合并症）、4 个术中变量（阑尾坏疽、穿孔、腹膜炎程度和引流管放置）和 2 个术后变量（立即入住 ICU 和并发症）。术后并发症的发生（OR 6.162，95%CI 2.451-15.493；p=0.000）和腹部引流管的放置（OR 3.438，95%CI 1.107-10.683；p=0.033）被发现是 LOS 延长的独立预测因素。对于未出现术后并发症的患者，引流管的放置是该结局的唯一独立预测因素（OR 7.853，95%CI 1.520-40.558；p=0.014）。敏感性分析显示出了确认性结果。
成人 CAA 行 LA 后的 LOS 与术中护理过程有明确的关联；因此，在这些情况下决定是否引流应更严格但谨慎地做出。
