在多病症患者中,非手术治疗尾炎是否安全有效?
Nicole Lunardi1, Jennie Meier1, Thai H Pham1
1Department of Surgery, University of Texas Southwestern, Dallas, TX; Department of Surgery, North Texas VA Health Care System, Dallas, TX.
对于多病症患者,非手术性尾炎管理减少了并发症,但与手术相比,死亡率增加. 临床试验结果可能不适用于这些复杂的患者.
科学领域:
- 外科手术 手术手术
- 胃肠病学 胃肠病学
- 临床试验 临床试验
背景情况:
- 急性尾炎的治疗包括手术 (手术) 和非手术 (保守) 的方法.
- 之前的临床试验通常集中在年轻,健康的人群中,这可能会限制概括性.
- 多病症患者代表了一个独特的群体,具有潜在不同的治疗结果.
研究的目的:
- 为了比较在多病症患者中急性尾炎的手术与非手术治疗后治疗结果.
- 评估多病症患者的结果与通常在临床试验中纳入的年轻,更健康人群的结果是否不同.
- 评估现有的尾炎治疗指南对复杂患者群体的通用性.
主要方法:
- 使用国家住院患者样本 (2004-2017) 进行回顾性队列研究.
- 包括368,537名患有急性无并发性尾炎的患者,按并发症状况 (0或2+) 分类.
- 使用倾向分数和概率灵敏度分析,比较住院患者的发病率,死亡率,住院时间和成本.
主要成果:
- 20%的多病患者使用非手术治疗,而没有并发症的患者仅占5%.
- 对于多病症患者来说,与手术相比,非手术治疗减少了3.5%的并发症,但死亡率增加了1.5%.
- 在所有患者群体中,手术与更短的住院时间和更低的成本有关.
结论:
- 这些发现挑战了对手术和非手术尾炎管理进行比较的临床试验的概括性.
- 多病症患者的结果与在年轻,更健康的人群中观察到的结果有显著差异.
- 尾炎的治疗指南可能需要改进,以考虑到患者的并发症状况.
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