DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA.
Ryder Trauma Center, Jackson Memorial Hospital, Miami, Florida, USA.
Surg Infect (Larchmt). 2023 Sep;24(7):613-618. doi: 10.1089/sur.2023.109. Epub 2023 Aug 30.
We sought to understand which factors are associated with open appendectomy as final operative approach. We hypothesize that higher American Association for the Surgery of Trauma (AAST) Emergency General Surgery (EGS) grade is associated with open appendectomy. Post hoc analysis of the Eastern Association for the Surgery of Trauma (EAST) Multicenter Study of the Treatment of Appendicitis in America: Acute, Perforated and Gangrenous (MUSTANG) prospective appendicitis database was performed. All adults (age >18) undergoing appendectomy were stratified by final operative approach: laparoscopic or open appendectomy (including conversion from laparoscopic). Univariable analysis was performed to compare group characteristics and outcomes, and multivariable logistic regression was performed to identify demographic, clinical, or radiologic factors associated with open appendectomy. A total of 3,019 cases were analyzed. One hundred seventy-five (5.8%) patients underwent open appendectomy, including 127 converted from laparoscopic to open. The median age was 37 (25) years and 53% were male. Compared with the laparoscopic group, open appendectomy patients had more comorbidities, higher proportion of symptoms greater than 96 hours, and higher AAST EGS grade. Moreover, on intraoperative findings, the open appendectomy group had a higher incidence of perforated and gangrenous appendicitis with purulent contamination, abscess/phlegmon, and purulent abdominal/pelvic fluid. On multivariable analysis controlling for comorbidities, clinical and imaging AAST grade, duration of symptoms, and intra-operative findings, only AAST Clinical Grade 5 appendicitis was independently associated with open appendectomy (odds ratio [OR], 5.63; 95% confidence interval [CI], 1.24-25.55; p = 0.025). In the setting of appendicitis, generalized peritonitis (AAST Clinical Grade 5) is independently associated with greater odds of open appendectomy.
我们试图了解哪些因素与最终采用开腹手术有关。我们假设美国创伤外科学会（AAST）急诊普通外科（EGS）分级较高与开腹阑尾切除术有关。对东部创伤外科学会（EAST）多中心美国阑尾炎治疗研究：急性、穿孔和坏疽（MUSTANG）前瞻性阑尾炎数据库进行了事后分析。所有接受阑尾切除术的成年人（年龄>18 岁）按最终手术方法分层：腹腔镜或开腹阑尾切除术（包括从腹腔镜转为开腹）。采用单变量分析比较组间特征和结果，采用多变量逻辑回归分析确定与开腹阑尾切除术相关的人口统计学、临床或影像学因素。共分析了 3019 例病例。175 例（5.8%）患者接受了开腹阑尾切除术，其中 127 例从腹腔镜转为开腹。中位年龄为 37（25）岁，53%为男性。与腹腔镜组相比，开腹阑尾切除术患者合并症更多，症状持续时间超过 96 小时的比例更高，AAST EGS 分级更高。此外，在术中发现方面，开腹阑尾切除术组穿孔性和坏疽性阑尾炎伴脓性污染、脓肿/蜂窝织炎和脓性腹腔/盆腔积液的发生率更高。在多变量分析中，控制合并症、临床和影像学 AAST 分级、症状持续时间和术中发现后，只有 AAST 临床分级 5 级阑尾炎与开腹阑尾切除术独立相关（比值比 [OR]，5.63；95%置信区间 [CI]，1.24-25.55；p=0.025）。在阑尾炎的情况下，弥漫性腹膜炎（AAST 临床分级 5 级）与开腹阑尾切除术的可能性增加独立相关。
