在高风险患者中非手术治疗尾炎的潜在风险
Nicole Lunardi1, Melissa Thornton1, Ben L Zarzaur2
1Department of Surgery, University of Texas Southwestern, Dallas, TX; Department of Surgery, North Texas VA Health Care System, Dallas, TX.
Surgery
|September 26, 2024
概括
对急性尾炎的非手术治疗可能会降低并发症,但会增加高风险患者的死亡率和成本. 外科医生应该仔细考虑这种方法对弱势个体.
科学领域:
- 外科手术 手术手术
- 胃肠病学 胃肠病学
- 医疗保健服务研究 医疗服务研究
背景情况:
- 急性尾炎的非手术治疗越来越受欢迎,通常被认为对高风险患者来说更安全.
- 这种假设缺乏关于比较风险和结果的强有力的证据.
研究的目的:
- 评估非手术治疗与急性尾炎手术的结果,这些患者被确定为手术并发症的高风险患者.
主要方法:
- 使用2004-2017年全国住院患者样本进行的回顾性队列研究.
- 一个逻辑回归模型预测了手术风险,应用于非手术治疗的患者.
- 在高风险患者中,反向概率权重比较了非手术和手术组之间的结果.
主要成果:
- 在21,242名高风险患者中,非手术治疗显示并发症减少了9%,死亡率增加了2%.
- 非手术护理导致医院费用增加 (10,202美元增加),住院时间更长 (3天),并增加了向熟练护理机构的出院 (9%).
结论:
- 高风险尾炎患者的非手术治疗可能会降低发病率,但会增加死亡率,长时间住院和更高成本的风险.
- 建议外科医生在这个脆弱的患者群体中考虑非手术策略时谨慎行事.
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