Department of Gastrointestinal Surgery, The Second Nanning People's Hospital, The Third Affiliated Hospital of Guangxi Medical University, Nanning, 530031, Guangxi Zhuang Autonomous Region, China.
Pediatr Surg Int. 2024 Aug 8;40(1):217. doi: 10.1007/s00383-024-05752-7.
This study aimed to assess the impact of peritoneal drainage and its type on prognosis, encompassing postoperative recovery and complications, in pediatric patients (≤ 16 years old) following appendectomy based on the grade of appendicitis.
In this retrospective study, we analyzed pediatric patients (≤ 16 years old) with appendicitis who met the inclusion and exclusion criteria in our center from January 2017 to January 2024 and classified them into grade I-V based on the grade of appendicitis, with V representing the most serious cases. The patients were grouped according to drainage status and type. The main clinical outcomes included postoperative rehabilitation indexes such as time to resume a soft diet, time to remove the drain, duration of postoperative antibiotic use and length of hospitalization (LOH), as well as postoperative complications including intra-abdominal abscess (IAA), ileus and wound infection (WI), and readmission within 30 days after surgery.
A total of 385 pediatric patients with appendicitis were included in the study and divided into No-drainage (ND) group (n = 74), Passive drainage (PD) group (n = 246) and Active drainage (AD) group (n = 65) according to drainage status and type. Compared to the other two groups, the ND group had a significantly shorter time to resume a soft diet, duration of postoperative antibiotic use and LOH, and these differences were statistically significant. Similar findings were observed in grade I patients too (P < 0.05). In all cases examined here, the AD group had a significantly shorter time for drain removal compared to the PD group (3.04 [1-12] vs 2.74 [1-15], P = 0.049); this difference was also evident among grade I patients (2.80 [1-6] vs 2.47 [1-9], P = 0.019). Furthermore, within the same grade, only in grade IV did the AD group exhibit a shorter duration of postoperative antibiotic use compared to the PD group (4.75 [4-5] vs 8.33 [5-15], P = 0.009). Additionally, the LOH in the AD group was longer than that in the PD group (8.00 [4-13] vs 4.75 [4-5], P = 0.025). Among all cases, the ND group exhibited significantly lower incidences of overall complications and WI compared to the other two groups (P < 0.05). Additionally, the incidence of IAA in the ND group was significantly lower than that in the PD group (0% vs 5.3%, P = 0.008 < 0.0167). Furthermore, although there were no statistically significant differences in the incidence of overall complications, IAA, ileus, and WI between the PD and AD groups during grade ≥ II analysis (P > 0.05), a higher readmission rate within 30 days was observed in the PD group compared to the AD group; however, these differences were not statistically significant (P > 0.05). Moreover, multivariate analysis revealed that a higher grade of appendicitis was associated with an increased risk of overall complications and IAA as well as a longer duration of postoperative antibiotic use and LOH.
The appendicitis grade is a crucial indicator for predicting postoperative IAA and LOH. In patients with grade I appendicitis, peritoneal drainage, even if active drainage, is not recommended; For patients with grade ≥ II appendicitis, active drainage may be more effective than passive drainage in reducing the duration of postoperative antibiotic use and LOH.
本研究旨在评估基于阑尾炎分级的术后恢复和并发症等预后因素，评估小儿（≤ 16 岁）阑尾切除术后腹膜引流及其类型的影响。
本回顾性研究分析了我院 2017 年 1 月至 2024 年 1 月期间符合纳入和排除标准的小儿（≤ 16 岁）阑尾炎患者，根据阑尾炎分级将其分为 I-V 级，V 级表示最严重的情况。根据引流状态和类型将患者分为无引流（ND）组（n = 74）、被动引流（PD）组（n = 246）和主动引流（AD）组（n = 65）。主要临床结局包括术后康复指标，如恢复软食时间、引流管拔除时间、术后抗生素使用时间和住院时间（LOH），以及术后并发症，包括腹腔脓肿（IAA）、肠梗阻和伤口感染（WI），以及术后 30 天内再入院。
共纳入 385 例阑尾炎患儿，根据引流状态和类型分为无引流（ND）组（n = 74）、被动引流（PD）组（n = 246）和主动引流（AD）组（n = 65）。与其他两组相比，ND 组的恢复软食时间、术后抗生素使用时间和 LOH 明显较短，差异具有统计学意义。在 I 级患者中也观察到类似的发现（P < 0.05）。在所有检查的病例中，AD 组的引流管拔除时间明显短于 PD 组（3.04[1-12]比 2.74[1-15]，P = 0.049）；在 I 级患者中也有明显差异（2.80[1-6]比 2.47[1-9]，P = 0.019）。此外，在同一分级中，只有在 IV 级时，AD 组的术后抗生素使用时间明显短于 PD 组（4.75[4-5]比 8.33[5-15]，P = 0.009）。此外，AD 组的 LOH 比 PD 组长（8.00[4-13]比 4.75[4-5]，P = 0.025）。在所有病例中，ND 组的总体并发症和 WI 的发生率明显低于其他两组（P < 0.05）。此外，ND 组的 IAA 发生率明显低于 PD 组（0%比 5.3%，P = 0.008 < 0.0167）。此外，尽管在 II 级以上分析中，PD 组和 AD 组的总体并发症、IAA、肠梗阻和 WI 的发生率无统计学差异（P > 0.05），但 PD 组的 30 天内再入院率明显高于 AD 组；然而，这些差异无统计学意义（P > 0.05）。此外，多因素分析显示，阑尾炎分级越高，总体并发症和 IAA 的风险增加，以及术后抗生素使用时间和 LOH 延长的风险增加。
阑尾炎分级是预测术后 IAA 和 LOH 的重要指标。对于 I 级阑尾炎患者，不建议进行腹膜引流，即使是主动引流；对于 II 级以上的阑尾炎患者，主动引流可能比被动引流更能有效减少术后抗生素使用时间和 LOH。
