治疗急性尾炎的策略和基于入院时危急疾病的死亡率:一项观察性研究
Samantha King1, Jennifer Proper2, Lianne K Siegel2
1Division of Plastic Surgery, University of Washington, Seattle, Washington, USA.
尾炎的手术,包括腹腔镜和开放手术,与非手术治疗相比,显著减少死亡率和住院时间,即使是在重症患者中. 危急疾病本身是不利结果的主要预测因素.
科学领域:
- 外科手术 手术手术
- 临界护理医学 临界护理医学
- 医疗保健服务研究 医疗服务研究
背景情况:
- 对尾炎的非手术治疗 (NOM) 在一般人群中显示出非劣势性.
- 患有尾炎的重症患者在很大程度上被排除在以前的NOM研究之外.
- 了解这种脆弱群体的治疗结果对于临床决策至关重要.
研究的目的:
- 为了比较危急病患者尾炎的手术和非手术治疗 (NOM) 之间的死亡率和住院时间 (LOS).
- 确定关键疾病并发症对治疗结果的影响.
主要方法:
- 对18岁以上急性尾炎患者的医疗成本和利用计划 (HCUP) 数据库 (2008-2015) 的分析.
- 纳入国际疾病分类,第九次修订 (ICD-9) 的诊断代码.
- 使用负二项和逻辑回归来评估伴随性疾病 (急性功能衰竭,心血管功能衰竭,肺功能衰竭,败血症) 和治疗策略 (腹腔镜,开放,NOM或两者) 与死亡率和医院LOS之间的关联.
主要成果:
- 在464,123名患者中,67.5%采用了腹腔镜,23.3%采用了开放式,8.2%采用了NOM,0.8%采用了两种手术方法.
- 与NOM相比,手术管理 (腹腔镜和开放式) 与58%较低的死亡率和34%较短的医院LOS相关.
- 危急疾病显著增加了死亡率 (102-666%更高的几率) 和医院LOS (47-163%更长).
结论:
- 入院时的危急疾病在尾炎患者的死亡率和医院LOS大幅增加.
- 外科尾切除术 (透视和开放) 改善了生存率,并减少了与NOM相比的住院时间,无论病情如何.
- 在危急性尾炎患者中,由于结果较差,应仔细考虑NOM.
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