Department of Surgery, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA.
Department of Surgery, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA.
Am J Surg. 2023 Aug;226(2):256-260. doi: 10.1016/j.amjsurg.2023.05.002. Epub 2023 May 14.
Perforated appendicitis is often managed nonoperatively though upfront surgery is becoming more common. We describe postoperative outcomes for patients undergoing surgery at their index hospitalization for perforated appendicitis.
We used the 2016-2020 National Surgical Quality Improvement Program database to identify patients with appendicitis who underwent appendectomy or partial colectomy. The primary outcome was surgical site infection (SSI).
132,443 patients with appendicitis underwent immediate surgery. Of 14.1% patients with perforated appendicitis, 84.3% underwent laparoscopic appendectomy. Intra-abdominal abscess rates were lowest after laparoscopic appendectomy (9.4%). Open appendectomy (OR 5.14, 95% CI 4.06-6.51) and laparoscopic partial colectomy (OR 4.60, 95% CI 2.38-8.89) were associated with higher likelihoods of SSIs.
Upfront surgical management of perforated appendicitis is now predominantly approached by laparoscopy, often without bowel resection. Postoperative complications occurred less frequently with laparoscopic appendectomy compared to other approaches. Laparoscopic appendectomy during the index hospitalization is an effective approach to perforated appendicitis.
尽管穿孔性阑尾炎通常采用非手术治疗，但直接手术治疗越来越常见。我们描述了在穿孔性阑尾炎首次住院期间接受手术治疗的患者的术后结局。
我们使用了 2016-2020 年国家手术质量改进计划数据库，以确定接受阑尾切除术或部分结肠切除术的阑尾炎患者。主要结局是手术部位感染（SSI）。
132443 例阑尾炎患者立即接受了手术。在穿孔性阑尾炎患者中，14.1%的患者接受了腹腔镜阑尾切除术。腹腔镜阑尾切除术后的腹腔脓肿发生率最低（9.4%）。开腹阑尾切除术（OR5.14，95%CI4.06-6.51）和腹腔镜部分结肠切除术（OR4.60，95%CI2.38-8.89）与 SSI 的可能性增加相关。
目前，穿孔性阑尾炎的直接手术治疗主要采用腹腔镜方法，通常无需肠道切除。与其他方法相比，腹腔镜阑尾切除术术后并发症发生的频率较低。在首次住院期间进行腹腔镜阑尾切除术是治疗穿孔性阑尾炎的有效方法。
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