Pouke Anne, Ylimartimo Aura, Nurkkala Juho, Lahtinen Sanna, Koskela Marjo, Vakkala Merja, Kaakinen Timo, Raatiniemi Lasse, Liisanantti Janne
Research Unit of Translational Medicine, MRC Oulu, Oulu University.
Department of Anesthesiology, Oulu University Hospital.
Ann Med Surg (Lond). 2024 Aug 22;86(10):5704-5710. doi: 10.1097/MS9.0000000000002498. eCollection 2024 Oct.
Emergency laparotomy (EL) is a common surgical procedure with high rates of mortality and complications. Socio-economic circumstances and regional differences have an influence on the utilization of care and outcomes in many diagnostic groups, but there are only a few studies focusing on their effect in EL population. The aim of this study was to examine the socio-economic and regional differences in the rate of EL within one tertiary care hospital district.
Retrospective single-center study of 573 patients who underwent EL in Oulu University Hospital between May 2015 and December 2017. The postal code area of each patient's home address was used to determine the socio-economic status and rurality of the location of residence.
The age-adjusted rate of EL was higher in patients from low-income areas compared to patients from high-income areas [1.46 ((95% CI 1.27-1.64)) vs. 1.15 (95% CI, 0.96-1.34)]. The rate of EL was higher in rural areas compared to urban areas [1.29 (95% CI 1.17-1.41 vs. 1.42 (1.18-1.67)]. Peritonitis was more common in patients living in low-income areas. There were no differences in operation types or mortality between the groups.
The study findings suggest that there are socio-economic and regional differences in the need of EL. The patients living in low-income areas had a higher rate of EL and a higher rate of peritonitis. These differences cannot be explained by patient demographics or comorbidities alone.
急诊剖腹手术（EL）是一种常见的外科手术，死亡率和并发症发生率都很高。社会经济状况和地区差异会影响许多诊断组别的医疗利用情况和治疗结果，但仅有少数研究关注它们对急诊剖腹手术人群的影响。本研究的目的是调查在一个三级医疗院区范围内急诊剖腹手术率的社会经济和地区差异。
对2015年5月至2017年12月期间在奥卢大学医院接受急诊剖腹手术的573例患者进行回顾性单中心研究。使用每位患者家庭住址的邮政编码区域来确定居住地点的社会经济状况和农村程度。
与高收入地区的患者相比，低收入地区患者的年龄调整后急诊剖腹手术率更高[1.46（（95%置信区间1.27 - 1.64））对1.15（95%置信区间，0.96 - 1.34）]。农村地区的急诊剖腹手术率高于城市地区[1.29（95%置信区间1.17 - 1.41对1.42（1.18 - 1.67）]。低收入地区的患者腹膜炎更为常见。两组之间的手术类型或死亡率没有差异。
研究结果表明，急诊剖腹手术需求存在社会经济和地区差异。生活在低收入地区的患者急诊剖腹手术率更高，腹膜炎发生率也更高。这些差异不能仅由患者人口统计学特征或合并症来解释。
