Yamada Takeshi, Endo Hideki, Hasegawa Hiroshi, Kimura Toshimoto, Kakeji Yoshihiro, Koda Keiji, Ishida Hideyuki, Sakamoto Kazuhiro, Hirata Keiji, Yamamoto Hiroyuki, Miyata Hiroaki, Matsuda Akihisa, Yoshida Hiroshi, Kitagawa Yuko
Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery Nippon Medical School Tokyo Japan.
Department of Healthcare Quality Assessment Graduate School of Medicine The University of Tokyo Tokyo Japan.
Ann Gastroenterol Surg. 2020 Nov 9;5(2):236-242. doi: 10.1002/ags3.12408. eCollection 2021 Mar.
Appendicitis is divided into two categories: complicated appendicitis (CA) and uncomplicated appendicitis (UA). In pediatric patients with CA, the use of interval appendectomy (IA), which is non-operative management followed by elective surgery, has decreased the number of postoperative complications. Before discussing the merit of IA for adult patients, we need to clarify whether the frequency and seriousness of the complication rate after emergency surgery is higher for CA than for UA.
This retrospective cohort study included adult patients who underwent appendectomy and who were registered in the National Clinical Database (NCD) from 2014 to 2016. Patients with CA who underwent emergency appendectomy comprised the CA group. Patients with UA comprised the UA group. Patients with chronic or recurrent appendicitis who underwent elective appendectomy comprised the elective appendectomy (EA) group. Primary outcomes were all morbidity, serious morbidity, and mortality within 30 days after appendectomy.
We included 109 256 patients in the study: 14 798 CA, 86 876 UA, and 7582 EA patients. Compared with the UA group, the rates of all morbidity, serious morbidity, and mortality were significantly higher in the CA group. All morbidity, serious morbidity, and mortality rates were significantly lower in the EA group than in the other two groups.
We confirmed that emergency surgery for CA places the patient at relatively higher risk. We also showed that the risk associated with EA is significantly lower than that for the other methods.
阑尾炎分为两类：复杂性阑尾炎（CA）和非复杂性阑尾炎（UA）。在患有CA的儿科患者中，采用间隔期阑尾切除术（IA），即非手术治疗后进行择期手术，已减少了术后并发症的数量。在讨论IA对成年患者的益处之前，我们需要明确CA患者急诊手术后并发症发生率的频率和严重程度是否高于UA患者。
这项回顾性队列研究纳入了2014年至2016年在国家临床数据库（NCD）中登记的接受阑尾切除术的成年患者。接受急诊阑尾切除术的CA患者组成CA组。UA患者组成UA组。接受择期阑尾切除术的慢性或复发性阑尾炎患者组成择期阑尾切除术（EA）组。主要结局是阑尾切除术后30天内的所有发病率、严重发病率和死亡率。
我们在研究中纳入了109256例患者：14798例CA患者、86876例UA患者和7582例EA患者。与UA组相比，CA组的所有发病率、严重发病率和死亡率均显著更高。EA组中的所有发病率、严重发病率和死亡率均显著低于其他两组。
我们证实，CA患者的急诊手术使患者面临相对较高的风险。我们还表明，与EA相关的风险显著低于其他方法。
