From the Department of Surgery (M.-C.F.-M., L.P.S., R.M.F., C.L.E., J.O.S.), Hospital Clínico Universitario de Valencia; and Biomedical Research Institute (INCLIVA) (J.O.S.), University of Valencia, Valencia, Spain.
J Trauma Acute Care Surg. 2021 Jan 1;90(1):163-169. doi: 10.1097/TA.0000000000002957.
The impact of laparoscopic appendectomy (LA) on the incidence of intra-abdominal abscess (IAA) remains controversial. We aimed to identify risk factors for postappendectomy IAA and assess the impact of appendectomy approach in postoperative morbidity.
A retrospective single-center study including consecutive patients who underwent appendectomy for acute appendicitis between 2015 and 2018 was performed. Demographic, clinical, intraoperative, and perioperative variables were collected. Univariate and multivariate analyses was performed to detect independent risk factors for IAA. Comparison of LA and open appendectomy was conducted, and propensity score model (PSM) was used to overcome differences between groups. Independent risk factors for IAA were identified by univariate and multivariate analyses in the PSM cohort.
A total of 532 appendectomies were included. The median age was 35 years. Three hundred two patients (56.7%) underwent LA. The most frequent operative finding was American Association for the Surgery of Trauma (AAST) grade 1 appendicitis in 303 patients (57%). Peritonitis was found in 109 patients (20.5%). Postoperative morbidity and mortality were 14.4% and 0%, respectively. Intra-abdominal abscess rate was 6.2%. An AAST grade of ≥2, a preoperative C-reactive protein level of >100 mg/dL, and diabetes mellitus were identified as independent risk factors for IAA in the multivariate analysis. Comparing LA and open appendectomy, there were no differences in IAA rates. After PSM, LA showed lower morbidity and shorter hospital stay.
Laparoscopic appendectomy is a safe approach and not related to a higher risk of IAA. Patients with an AAST grade of ≥2, a preoperative C-reactive protein level of >100, and diabetes mellitus have higher risk for postappendectomy IAA.
Therapeutic/care management, level IV.
腹腔镜阑尾切除术（LA）对腹腔脓肿（IAA）发生率的影响仍存在争议。本研究旨在确定阑尾切除术后 IAA 的危险因素，并评估手术方式对术后发病率的影响。
回顾性分析 2015 年至 2018 年间连续接受阑尾切除术治疗急性阑尾炎的患者，收集患者的人口统计学、临床、手术和围手术期变量。进行单因素和多因素分析以确定 IAA 的独立危险因素。比较 LA 和开放阑尾切除术，并使用倾向评分模型（PSM）克服组间差异。在 PSM 队列中，通过单因素和多因素分析确定 IAA 的独立危险因素。
共纳入 532 例阑尾切除术，中位年龄为 35 岁，302 例（56.7%）患者接受 LA。最常见的手术发现是 303 例（57%）患者的美国创伤外科学会（AAST）分级 1 级阑尾炎。109 例（20.5%）患者出现腹膜炎。术后发病率和死亡率分别为 14.4%和 0%，IAA 发生率为 6.2%。多因素分析显示，AAST 分级≥2、术前 C 反应蛋白水平>100mg/dL 和糖尿病是 IAA 的独立危险因素。与开放阑尾切除术相比，LA 组的 IAA 发生率无差异。PSM 后，LA 组的发病率较低，住院时间较短。
LA 是一种安全的方法，与 IAA 风险增加无关。AAST 分级≥2、术前 C 反应蛋白水平>100、糖尿病的患者阑尾切除术后发生 IAA 的风险更高。
治疗/护理管理，IV 级。
