急性阑尾炎切除术后术后发病率、住院时间延长和再入院的风险因素。
Risk factors for postoperative morbidity, prolonged length of stay and hospital readmission after appendectomy for acute appendicitis.
机构信息
Department of General and Visceral Surgery, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Krankenhausstraße 12, 91054, Erlangen, Germany.
Department of General, Visceral, Thoracic and Vascular Surgery, University Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany.
出版信息
Eur J Trauma Emerg Surg. 2023 Jun;49(3):1355-1366. doi: 10.1007/s00068-023-02225-9. Epub 2023 Jan 28.
PURPOSE
The aim of the present study was to identify risk factors associated with postoperative morbidity and major morbidity, with a prolonged length of hospital stay and with the need of readmission in patients undergoing appendectomy due to acute appendicitis.
METHODS
We performed a retrospective analysis of 1638 adult patients who underwent emergency appendectomy for preoperatively suspected acute appendicitis from 2010 to 2020 at the University Hospital Erlangen. Data including patient demographics, pre-, intra-, and postoperative findings were collected and compared between different outcome groups (morbidity, major morbidity, prolonged length of postoperative hospital stay (LOS) and readmission) from those patients with verified acute appendicitis (n = 1570).
RESULTS
Rate of negative appendectomies was 4%. In patients with verified acute appendicitis, morbidity, major morbidity and readmission occurred in 6%, 3% and 2%, respectively. Mean LOS was 3.9 days. Independent risk factors for morbidity were higher age, higher preoperative WBC-count and CRP, lower preoperative hemoglobin, longer time to surgery and longer duration of surgery. As independent risk factors for major morbidity could be identified higher age, higher preoperative CRP, lower preoperative hemoglobin and longer time to surgery. Eight parameters were independent risk factors for a prolonged LOS: higher age, higher preoperative WBC-count and CRP, lower preoperative hemoglobin, need for conversion, longer surgery duration, presence of intraoperative complicated appendicitis and of postoperative morbidity. Presence of malignancy and higher preoperative WBC-count were independent risk factors for readmission.
CONCLUSION
Among patients undergoing appendectomy for acute appendicitis, there are relevant risk factors predicting postoperative complications, prolonged hospital stays and readmission. Patients with the presence of the identified risk factors should receive special attention in the postoperative course and may benefit from a more individualized therapy.
目的
本研究旨在确定与术后发病率和主要发病率、住院时间延长以及因急性阑尾炎而行阑尾切除术的患者需要再次入院相关的风险因素。
方法
我们对 2010 年至 2020 年期间在埃尔兰根大学医院因术前疑似急性阑尾炎而行急诊阑尾切除术的 1638 例成年患者进行了回顾性分析。收集了包括患者人口统计学、术前、术中、术后资料在内的数据，并在不同结局组（发病率、主要发病率、术后住院时间延长和再次入院）之间进行了比较，这些患者均被证实患有急性阑尾炎（n=1570）。
结果
阴性阑尾切除术的发生率为 4%。在被证实患有急性阑尾炎的患者中，发病率、主要发病率和再次入院的发生率分别为 6%、3%和 2%。平均住院时间为 3.9 天。发病率的独立危险因素为年龄较大、术前白细胞计数和 C 反应蛋白较高、术前血红蛋白较低、手术时间较长以及手术持续时间较长。主要发病率的独立危险因素为年龄较大、术前 C 反应蛋白较高、术前血红蛋白较低以及手术时间较长。8 个参数是住院时间延长的独立危险因素：年龄较大、术前白细胞计数和 C 反应蛋白较高、术前血红蛋白较低、需要转换、手术持续时间较长、术中并发阑尾炎和术后发病率。存在恶性肿瘤和较高的术前白细胞计数是再次入院的独立危险因素。
结论
在因急性阑尾炎而行阑尾切除术的患者中，存在与术后并发症、住院时间延长和再次入院相关的相关风险因素。存在已确定风险因素的患者在术后期间应特别关注，可能受益于更个体化的治疗。
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