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首页> 外文期刊>Surgical Endoscopy >Predictors for prolonged length of stay after laparoscopic appendectomy for complicated acute appendicitis in adults
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Predictors for prolonged length of stay after laparoscopic appendectomy for complicated acute appendicitis in adults

机译：腹腔镜阑尾切除术治疗成年人复杂急性阑尾炎后长时间保持的预测因子

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Background Appendicitis-related hospitalizations linked with peritonitis or postoperative complications result in longer lengths of stay and higher costs. The aim of the present study was to assess the independent association between potential predictors and prolonged hospitalization after laparoscopic appendectomy (LA) for complicated acute appendicitis (CAA). Methods A retrospective cohort study was conducted on adult patients diagnosed with CAA in which LA was attempted. The primary outcome was a prolonged length of stay (LOS) after surgery, defined as hospitalizations longer than or equal to the 75th percentile for LOS, including the day of discharge. Hierarchical regression models were run to elucidate the independent predictors for the variable of interest. Results The present study involved 160 patients with a mean age of 50.71 years. The conversion rate was 1.9%, and the overall postoperative morbidity rate was 23.8%. The median length of stay (LOS) was 5 days (75th percentile: 7 days). Multivariate analyses included nine variables that are statistically and/or clinically relevant to assess its relationship with a prolonged LOS: three preoperative (age, sex, and comorbidity), four intraoperative (appendix gangrene, perforation, degree of peritonitis, and drain placement), and two postoperative (immediate ICU admission and complications). The development of postoperative complications (OR 6.162, 95% CI 2.451-15.493;p = 0.000) and the placement of an abdominal drain (OR 3.438, 95% CI 1.107-10.683;p = 0.033) were found to be independent predictors for prolonged LOS. For patients not presenting postoperative complications, drain placement was the only independent predictor for the outcome (OR 7.853, 95% CI 1.520-40.558;p = 0.014). Sensitivity analyses showed confirmatory results. Conclusion The intraoperative process of care has a clear impact on LOS after LA for CAA in adults; therefore, the decision of whether to drain in these situations should be made more restrictively yet with judicious caution.
机译：背景与腹膜炎或术后并发症相关的阑尾炎相关的住院治疗会导致更长的住院时间和更高的费用。本研究的目的是评估潜在预测因素与复杂急性阑尾炎（CAA）腹腔镜阑尾切除术（LA）后住院时间延长之间的独立相关性。方法对成人CAA患者进行回顾性队列研究。主要结果是术后住院时间延长（LOS），定义为住院时间大于或等于LOS的第75百分位，包括出院日。运行分层回归模型来阐明感兴趣变量的独立预测因子。结果本研究涉及160例患者，平均年龄50.71岁。转化率为1.9%，术后总发病率为23.8%。平均住院时间（LOS）为5天（第75百分位：7天）。多变量分析包括九个与LOS延长相关的统计和/或临床变量：三个术前变量（年龄、性别和共病）、四个术中变量（阑尾坏疽、穿孔、腹膜炎程度和引流管放置）和两个术后变量（立即入住ICU和并发症）。术后并发症的发生（OR 6.162，95%可信区间2.451-15.493；p=0.000）和腹腔引流管的放置（OR 3.438，95%可信区间1.107-10.683；p=0.033）被认为是延长LOS的独立预测因素。对于没有出现术后并发症的患者，引流管放置是预后的唯一独立预测因素（OR 7.853，95%可信区间1.520-40.558；p=0.014）。敏感性分析显示了确凿的结果。结论成人CAA术中护理对LA术后LOS有明显影响；因此，在这些情况下是否排水的决定应该更加严格，但要谨慎。

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