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Trend, variability, and outcome of open vs. laparoscopic appendectomy based on a large administrative database

机译：基于大型管理数据库的开放式与腹腔镜阑尾切除术的趋势，变异性和结果

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The aim of this study was to ascertain the variability and 9-year trends in the use of laparoscopic surgery for appendicitis using data from a large administrative database, to compare the effectiveness and efficiency of laparoscopic (LA) and open appendectomy, and to ascertain whether different choices of surgical approach stem from evidence-based recommendations. This was a retrospective cohort study based on administrative data collected from 2000 to 2008 in the Veneto Region (northeastern Italy). Funnel plots were used to display variability between local health units (LHUs). A total of 38,314 appendectomies were performed from 2000 to 2008 in the Veneto Region, 53% of them in males. The laparoscopic procedure was used more often for females than for males of fertile age. There was a significant rising linear trend in the use of LA, with a higher increment among females. The overall regional standardized appendectomy rate was 82.9/10,000. The mean proportion of LAs (27.3%) ranged from 2.8 to 59.4% at different LHUs, and there was no relationship between the volume of procedures undertaken and the proportion of LAs. The proportion of LAs performed in females of reproductive age also varied considerably, on no apparent evidence-based grounds. The analysis of aggregate clinical data is a powerful tool for supporting regional health management units in efforts to improve the quality of medical care and assess the appropriateness of therapeutic or diagnostic approaches in the light of practical guidelines. Variability in the treatment of a given disease that lacks any evidence-based justification remains an important issue in national health systems.
机译：这项研究的目的是使用大型行政数据库中的数据来确定腹腔镜手术治疗阑尾炎的变异性和9年趋势，以比较腹腔镜（LA）和开放式阑尾切除术的有效性和效率，并确定是否手术方法的不同选择源于基于证据的建议。这是一项回顾性队列研究，该研究基于威尼托大区（意大利东北部）2000年至2008年收集的行政数据。漏斗图用于显示本地卫生单位（LHU）之间的差异。从2000年到2008年，威尼托大区共进行了38314例阑尾切除术，其中53％为男性。女性比有生育能力的男性更常使用腹腔镜手术。使用LA的线性趋势显着上升，女性的线性上升趋势更大。总体区域标准化阑尾切除率为82.9 / 10,000。在不同的LHU中，LA的平均比例（27.3％）在2.8％至59.4％之间，并且所采取的手术量与LA的比例之间没有关系。在没有明显的循证依据的情况下，在育龄女性中进行LA的比例也有很大差异。汇总临床数据的分析是一种强大的工具，可支持区域卫生管理部门努力提高医疗质量，并根据实际准则评估治疗或诊断方法的适当性。缺乏任何循证依据的特定疾病的治疗变异性仍然是国家卫生系统中的重要问题。

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