腹腔镜阑尾切除术后经口与静脉抗生素治疗复杂性阑尾炎的术后恢复：一项集群随机集群交叉非劣效性研究的亚研究。
Postoperative recovery in peroral versus intravenous antibiotic treatment following laparoscopic appendectomy for complicated appendicitis: a substudy of a cluster randomized cluster crossover non-inferiority study.
机构信息
Department of Surgery, Slagelse Hospital, Fælledvej 11, DK-4200, Slagelse, Denmark.
Center for Surgical Science, Zealand University Hospital, 4600, Koege, Denmark.
出版信息
Langenbecks Arch Surg. 2024 Oct 9;409(1):303. doi: 10.1007/s00423-024-03491-w.
BACKGROUND
Acute appendicitis is the most common cause of abdominal pain requiring surgery, usually managed with laparoscopic appendectomy. In Denmark, the standard postoperative treatment for complicated cases involves intravenous antibiotics. This study compares peroral versus intravenous antibiotics in the context of fast-track surgery and Enhanced Recovery After Surgery (ERAS) protocols. Our objective is to evaluate the impact of peroral versus intravenous antibiotics on patient-reported outcomes following laparoscopic appendectomy for complicated appendicitis.
METHODS
This was a sub-study within a broader Danish cluster-randomized non-inferiority trial conducted at Zealand University Hospital, focusing on adult patients undergoing laparoscopic appendectomy for complicated appendicitis. Participants were randomized into two groups: one receiving a three-day course of peroral antibiotics and the other intravenous antibiotics after surgery. Recovery quality was assessed on the third postoperative day using the Quality of Recovery-15 (QoR-15) questionnaire.
RESULTS
The study included 54 patients, 23 in the peroral and 31 in the intravenous groups. The peroral group reported significantly better recovery outcomes, with higher QoR-15 scores (mean difference of 12 points, p < 0.001). They also experienced shorter hospital stays, averaging 47 h less than the intravenous group (p < 0.001). No significant differences between the groups were observed in readmissions or severe postoperative complications.
CONCLUSIONS
Peroral antibiotic administration after laparoscopic appendectomy for complicated appendicitis significantly improves patient recovery and reduces hospital stay compared to intravenous antibiotics. These results advocate a potential shift towards peroral antibiotic use in postoperative care, aligning with ERAS principles.
TRIAL REGISTRATION NUMBER
ClinicalTrials.gov NCT04803422.
背景
急性阑尾炎是最常见的需要手术治疗的腹痛原因，通常采用腹腔镜阑尾切除术治疗。在丹麦，复杂病例的标准术后治疗是静脉内使用抗生素。本研究比较了快速康复外科（ERAS）方案中经口与静脉内使用抗生素的情况。我们的目的是评估经口与静脉内使用抗生素对腹腔镜阑尾切除术后复杂阑尾炎患者报告结局的影响。
方法
这是在丹麦泽兰大学医院进行的一项更广泛的、基于群组的非劣效性试验的子研究，主要针对接受腹腔镜阑尾切除术治疗复杂阑尾炎的成年患者。参与者被随机分为两组：一组接受三天疗程的经口抗生素治疗，另一组在手术后接受静脉内抗生素治疗。在术后第 3 天使用恢复质量 15 项问卷（QoR-15）评估恢复质量。
结果
该研究纳入了 54 例患者，其中 23 例接受经口组抗生素治疗，31 例接受静脉内组抗生素治疗。经口组报告的恢复结果明显更好，QoR-15 评分较高（平均差异 12 分，p<0.001）。他们的住院时间也较短，比静脉内组平均少 47 小时（p<0.001）。两组间在再入院或严重术后并发症方面无显著差异。
结论
与静脉内抗生素相比，腹腔镜阑尾切除术后复杂阑尾炎患者经口给予抗生素可显著改善患者的恢复情况并缩短住院时间。这些结果支持在术后护理中向经口抗生素使用的潜在转变，符合 ERAS 原则。
试验注册
ClinicalTrials.gov NCT04803422。
Zotero 插件