Warren J L, Penberthy L T, Addiss D G, McBean A M
Epidemiology Branch, Health Care Financing Administration, Baltimore, Maryland.
Surg Gynecol Obstet. 1993 Sep;177(3):288-94.
To assess the risks of adverse outcomes after appendectomy incidental to cholecystectomy among elderly Medicare beneficiaries, 8,936 persons undergoing cholecystectomy with incidental appendectomy and 44,461 persons undergoing cholecystectomy without incidental appendectomy were studied. Controlling for age, race, gender and co-morbidity status, the risk for wound infection in persons with incidental appendectomy was 83 percent higher than in persons without incidental appendectomy (95 percent confidence interval, 1.53 to 2.18). The risks for having other adverse outcomes, including other infections, extensive intrahospital complications and mortality rate at 30 days, were also higher for the former group, although these differences were not statistically significant. In addition, the demographic characteristics and health status of persons undergoing cholecystectomy with incidental appendectomy with persons undergoing cholecystectomy only were compared. Males, persons of younger ages, of white race or with no co-morbid conditions, were significantly more likely to undergo cholecystectomy with incidental appendectomy. Variables to control for differences in the demographic characteristics and health status between persons receiving and not receiving incidental appendectomy were included in the regression models for adverse outcomes. However, these models may not completely control for differences between the two groups. As a result, the actual relationship between incidental appendectomy and adverse outcomes may be underestimated. The preventive effect of incidental appendectomy on morbidity and mortality rates from future instances of appendicitis was assessed by determining the remaining lifetime risk for acute appendicitis. For persons 65 to 69 years of age, 115 incidental appendectomies would be required to prevent one future instance of appendicitis and 4,472 incidental appendectomies would be needed to prevent a single future death from acute appendicitis. Because incidental appendectomy increases the risk for wound infection among persons undergoing cholecystectomy and because the lifetime risk for acute appendicitis is relatively low for persons of this age group, surgeons should carefully consider the risks and benefits of incidental appendectomy in the elderly.
为评估老年医疗保险受益人群中胆囊切除术中附带阑尾切除术后出现不良后果的风险，研究了8936例行胆囊切除术并附带阑尾切除术的患者以及44461例行胆囊切除术但未附带阑尾切除术的患者。在控制年龄、种族、性别和合并症状况后，附带阑尾切除术患者的伤口感染风险比未附带阑尾切除术患者高83%（95%置信区间为1.53至2.18）。前一组出现其他不良后果的风险，包括其他感染、严重院内并发症和30天死亡率，也更高，尽管这些差异无统计学意义。此外，还比较了行胆囊切除术并附带阑尾切除术患者与仅行胆囊切除术患者的人口统计学特征和健康状况。男性、年龄较小者、白人或无合并症者行胆囊切除术并附带阑尾切除术的可能性显著更高。在不良后果回归模型中纳入了用于控制接受和未接受附带阑尾切除术患者人口统计学特征和健康状况差异的变量。然而，这些模型可能无法完全控制两组之间的差异。因此，附带阑尾切除术与不良后果之间的实际关系可能被低估。通过确定未来患急性阑尾炎的终生风险，评估了附带阑尾切除术对未来阑尾炎发病率和死亡率的预防效果。对于65至69岁的人群，需要进行115次附带阑尾切除术才能预防未来一例阑尾炎，需要进行4472次附带阑尾切除术才能预防一例因急性阑尾炎导致的未来死亡。由于附带阑尾切除术会增加胆囊切除术患者的伤口感染风险，且该年龄组人群患急性阑尾炎的终生风险相对较低，外科医生应仔细权衡老年患者附带阑尾切除术的风险和益处。
