From the Department of Anesthesiology and Pain Management' University of Texas Southwestern Medical Center, Dallas, Texas.
Health Equity Research Group, School of Medicine, Universidad Nacional de Colombia, Bogotá, Colombia.
Anesth Analg. 2023 Jun 1;136(6):1030-1038. doi: 10.1213/ANE.0000000000006336. Epub 2023 May 19.
Major disparities in complications and mortality after appendectomy between countries with different income levels have not been well characterized, as comparative studies at patient level between countries are scant. This study aimed to investigate variations in postoperative complications, mortality, and failure to rescue after appendectomy between a high-income country and a low-to-middle-income country.
Hospital discharges on adult patients who underwent appendectomy were extracted from administrative databases from Colombia and 2 states of the United States (Florida and New York). Outcomes included major postoperative complications, in-hospital mortality, and failure to rescue. Univariate analyses were conducted to compare outcomes between the 2 countries. Multivariable logistic regression analyses were conducted to examine the independent effect of country on outcomes after adjustment for patient age, sex, comorbidity index, severity of appendicitis, and appendectomy route (laparoscopic/open).
A total of 62,338 cases from Colombia and 57,987 from the United States were included in the analysis. Patients in Colombia were significantly younger and healthier but had a higher incidence of peritonitis. Use of laparoscopy was significantly lower in Colombia (5.9% vs 89.4%; P < .0001). After adjustment for covariates, multivariable logistic regression analyses revealed that compared to the United States, Colombia had lower complication rates (2.8% vs 6.6%; odds ratio [OR], 0.41; 95% confidence interval [CI], 0.39-0.44; P < .0001) but higher mortality (0.44% vs 0.08%; OR, 8.92; 95% CI, 5.69-13.98; P < .0001) and failure to rescue (13.6% vs 1.0%; OR, 17.01; 95% CI, 10.66-27.16; P < .0001).
Despite lower rates of postoperative complications, in-hospital mortality after appendectomy was higher in Colombia than in the United States. This difference may be explained by higher rates of failure to rescue in the low-to-middle-income country (ie, decreased ability of Colombian hospitals to rescue patients from complications).
不同收入水平国家之间阑尾切除术术后并发症和死亡率存在显著差异，但国家间患者层面的比较研究很少。本研究旨在探讨高收入国家和中低收入国家之间阑尾切除术术后并发症、死亡率和救援失败的差异。
从哥伦比亚和美国 2 个州（佛罗里达州和纽约州）的行政数据库中提取接受阑尾切除术的成年患者的住院记录。主要结局包括术后主要并发症、院内死亡率和救援失败。对两国之间的结局进行单变量分析。进行多变量逻辑回归分析，以检查在调整患者年龄、性别、合并症指数、阑尾炎严重程度和阑尾切除术途径（腹腔镜/开腹）后，国家对结局的独立影响。
共纳入哥伦比亚 62338 例和美国 57987 例患者。哥伦比亚患者明显更年轻、更健康，但腹膜炎发生率更高。哥伦比亚腹腔镜使用率明显较低（5.9% vs 89.4%；P <.0001）。在调整协变量后，多变量逻辑回归分析显示，与美国相比，哥伦比亚的并发症发生率较低（2.8% vs 6.6%；比值比 [OR]，0.41；95%置信区间 [CI]，0.39-0.44；P <.0001），但死亡率较高（0.44% vs 0.08%；OR，8.92；95% CI，5.69-13.98；P <.0001）和救援失败率较高（13.6% vs 1.0%；OR，17.01；95% CI，10.66-27.16；P <.0001）。
尽管术后并发症发生率较低，但哥伦比亚阑尾切除术术后的院内死亡率高于美国。这种差异可能是由于中低收入国家救援失败率较高（即哥伦比亚医院抢救并发症患者的能力下降）所致。
