Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA.
Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA.
Surg Infect (Larchmt). 2021 Oct;22(8):780-786. doi: 10.1089/sur.2019.258. Epub 2021 Apr 20.
We sought to assess the efficacy of prophylactic abdominal drainage to prevent complications after appendectomy for perforated appendicitis. In this post hoc analysis of a prospective multi-center study of appendicitis in adults (≥ 18 years), we included patients with perforated appendicitis diagnosed intra-operatively. The 634 subjects were divided into groups on the basis of receipt of prophylactic drains. The demographics and outcomes analyzed were surgical site infection (SSI), intra-abdominal abscess (IAA), Clavien-Dindo complications, secondary interventions, and hospital length of stay (LOS). Multivariable logistic regression for the cumulative 30-day incidence of IAA was performed controlling for age, Charlson Comorbidity Index (CCI), antibiotic duration, presence of drains, and Operative American Association for the Surgery of Trauma (AAST) Grade. In comparing the Drain (n = 159) versus No-Drain (n = 475) groups, there was no difference in the frequency of male gender (61% versus 55%; p = 0.168), weight (87.9 ± 27.9 versus 83.8 ± 23.4 kg; p = 0.071), Alvarado score (7 [6-8] versus 7 [6-8]; p = 0.591), white blood cell (WBC) count (14.8 ± 4.8 versus 14.9 ± 4.5; p = 0.867), or CCI (1 [0-3] versus 1 [0-2]; p = 0.113). The Drain group was significantly older (51 ± 16 versus 48 ± 17 years; p = 0.017). Drain use increased as AAST EGS Appendicitis Operative Severity Grade increased: Grade 3 (62/311; 20%), Grade 4 (46/168; 27%), and Grade 5 (51/155; 33%); p = 0.007. For index hospitalization, the Drain group had a higher complication rate (43% versus 28%; p = 0.001) and longer LOS (4 [3-7] versus 3 [1-5] days; p < 0.001). We could not detect a difference between the groups in the incidence of SSI, IAA, or secondary interventions. There was no difference in 30-day emergency department visits, re-admissions, or secondary interventions. Multi-variable logistic regression showed that only AAST Grade (odds ratio 2.7; 95% confidence interval7 1.5-4.7; p = 0.001) was predictive of the cumulative 30-day incidence of IAA. Prophylactic drainage after appendectomy for perforated appendicitis in adults is not associated with fewer intra-abdominal abscesses but is associated with longer hospital LOS. Increasing AAST EGS Appendicitis Operative Grade is a strong predictor of intra-abdominal abscess.
我们旨在评估预防性腹部引流术预防穿孔性阑尾炎手术后并发症的效果。在一项针对成人（≥18 岁）阑尾炎的前瞻性多中心研究的事后分析中，我们纳入了术中诊断为穿孔性阑尾炎的患者。634 名受试者根据是否接受预防性引流术进行分组。分析的人口统计学和结果包括手术部位感染（SSI）、腹腔脓肿（IAA）、Clavien-Dindo 并发症、二次干预和住院时间（LOS）。多变量逻辑回归分析了 30 天内累积 IAA 的发生率，控制了年龄、Charlson 合并症指数（CCI）、抗生素持续时间、引流管的存在和手术美国创伤外科学会（AAST）分级。在比较引流组（n=159）和非引流组（n=475）时，男性比例（61%对 55%；p=0.168）、体重（87.9±27.9 对 83.8±23.4kg；p=0.071）、Alvarado 评分（7[6-8]对 7[6-8]；p=0.591）、白细胞计数（14.8±4.8 对 14.9±4.5；p=0.867）或 CCI（1[0-3]对 1[0-2]；p=0.113）无差异。引流组年龄显著较大（51±16 对 48±17 岁；p=0.017）。随着 AAST EGS 阑尾炎手术严重程度分级的增加，引流的使用增加：3 级（62/311；20%）、4 级（46/168；27%）和 5 级（51/155；33%）；p=0.007。对于索引住院治疗，引流组的并发症发生率更高（43%对 28%；p=0.001），住院时间更长（4[3-7]对 3[1-5]天；p<0.001）。我们没有发现两组在 SSI、IAA 或二次干预的发生率上有差异。两组在 30 天内急诊就诊、再入院或二次干预方面没有差异。多变量逻辑回归显示，只有 AAST 分级（比值比 2.7；95%置信区间 1.5-4.7；p=0.001）是 30 天内累积 IAA 发生率的预测因素。成人穿孔性阑尾炎手术后预防性引流术并不能减少腹腔脓肿的发生，但与住院时间延长有关。AAST EGS 阑尾炎手术严重程度分级的增加是腹腔脓肿的一个强烈预测因素。
