Cargando…
Early versus late surgical management for complicated appendicitis in adults: a multicenter propensity score matching study
PURPOSE: Surgeons may be uncertain about the optimal timing of appendectomy to decrease complications, especially for complicated appendicitis. The aim of the study was to compare clinical outcomes between early and late surgery for complicated appendicitis. METHODS: A prospectively maintained datab...
Autores principales: | , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
The Korean Surgical Society
2019
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6669132/ https://www.ncbi.nlm.nih.gov/pubmed/31388511 http://dx.doi.org/10.4174/astr.2019.97.2.103 |
_version_ | 1783440320263880704 |
---|---|
author | Kim, Jeong Yeon Kim, Jong Wan Park, Jun Ho Kim, Byung Chun Yoon, Sang Nam |
author_facet | Kim, Jeong Yeon Kim, Jong Wan Park, Jun Ho Kim, Byung Chun Yoon, Sang Nam |
author_sort | Kim, Jeong Yeon |
collection | PubMed |
description | PURPOSE: Surgeons may be uncertain about the optimal timing of appendectomy to decrease complications, especially for complicated appendicitis. The aim of the study was to compare clinical outcomes between early and late surgery for complicated appendicitis. METHODS: A prospectively maintained database of complicated appendicitis was queried. Elective interval surgery (EIS) group and early surgery (ES) were matched with propensity score and marked with a prefix ‘p.’ Patient characteristics and surgical outcomes were compared. RESULTS: The propensity score-matched EIS group had a lower chance to underwent ileo-cecectomy or right hemicolectomy (1.5% vs. 6.9%, P = 0.031), a tendency of lower rate of postoperative complication (6.9% vs. 13.7%, P = 0.067), a lower rate of wound infection (1.5% vs. 8.4%, P = 0.010), and shorter postoperative hospital stay (3.72 days vs. 5.82 days, P < 0.001) than the propensity score-matched ES group. Multivariate analysis showed that delayed surgery for more than 48 hours or urgent surgery due to failure of EIS and open conversion were independent risk factors for postoperative complications (P = 0.001 and P = 0.025, respectively). In subgroup analysis, high American Society of Anesthesiologists physical status classification and distant abscess or generalized ascites in initial CT increased the risk of failure of EIS. CONCLUSION: EIS can be a useful option for selected adult patients with complicated appendicitis. |
format | Online Article Text |
id | pubmed-6669132 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | The Korean Surgical Society |
record_format | MEDLINE/PubMed |
spelling | pubmed-66691322019-08-06 Early versus late surgical management for complicated appendicitis in adults: a multicenter propensity score matching study Kim, Jeong Yeon Kim, Jong Wan Park, Jun Ho Kim, Byung Chun Yoon, Sang Nam Ann Surg Treat Res Original Article PURPOSE: Surgeons may be uncertain about the optimal timing of appendectomy to decrease complications, especially for complicated appendicitis. The aim of the study was to compare clinical outcomes between early and late surgery for complicated appendicitis. METHODS: A prospectively maintained database of complicated appendicitis was queried. Elective interval surgery (EIS) group and early surgery (ES) were matched with propensity score and marked with a prefix ‘p.’ Patient characteristics and surgical outcomes were compared. RESULTS: The propensity score-matched EIS group had a lower chance to underwent ileo-cecectomy or right hemicolectomy (1.5% vs. 6.9%, P = 0.031), a tendency of lower rate of postoperative complication (6.9% vs. 13.7%, P = 0.067), a lower rate of wound infection (1.5% vs. 8.4%, P = 0.010), and shorter postoperative hospital stay (3.72 days vs. 5.82 days, P < 0.001) than the propensity score-matched ES group. Multivariate analysis showed that delayed surgery for more than 48 hours or urgent surgery due to failure of EIS and open conversion were independent risk factors for postoperative complications (P = 0.001 and P = 0.025, respectively). In subgroup analysis, high American Society of Anesthesiologists physical status classification and distant abscess or generalized ascites in initial CT increased the risk of failure of EIS. CONCLUSION: EIS can be a useful option for selected adult patients with complicated appendicitis. The Korean Surgical Society 2019-08 2019-07-29 /pmc/articles/PMC6669132/ /pubmed/31388511 http://dx.doi.org/10.4174/astr.2019.97.2.103 Text en Copyright © 2019, the Korean Surgical Society http://creativecommons.org/licenses/by-nc/4.0/ Annals of Surgical Treatment and Research is an Open Access Journal. All articles are distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Original Article Kim, Jeong Yeon Kim, Jong Wan Park, Jun Ho Kim, Byung Chun Yoon, Sang Nam Early versus late surgical management for complicated appendicitis in adults: a multicenter propensity score matching study |
title | Early versus late surgical management for complicated appendicitis in adults: a multicenter propensity score matching study |
title_full | Early versus late surgical management for complicated appendicitis in adults: a multicenter propensity score matching study |
title_fullStr | Early versus late surgical management for complicated appendicitis in adults: a multicenter propensity score matching study |
title_full_unstemmed | Early versus late surgical management for complicated appendicitis in adults: a multicenter propensity score matching study |
title_short | Early versus late surgical management for complicated appendicitis in adults: a multicenter propensity score matching study |
title_sort | early versus late surgical management for complicated appendicitis in adults: a multicenter propensity score matching study |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6669132/ https://www.ncbi.nlm.nih.gov/pubmed/31388511 http://dx.doi.org/10.4174/astr.2019.97.2.103 |
work_keys_str_mv | AT kimjeongyeon earlyversuslatesurgicalmanagementforcomplicatedappendicitisinadultsamulticenterpropensityscorematchingstudy AT kimjongwan earlyversuslatesurgicalmanagementforcomplicatedappendicitisinadultsamulticenterpropensityscorematchingstudy AT parkjunho earlyversuslatesurgicalmanagementforcomplicatedappendicitisinadultsamulticenterpropensityscorematchingstudy AT kimbyungchun earlyversuslatesurgicalmanagementforcomplicatedappendicitisinadultsamulticenterpropensityscorematchingstudy AT yoonsangnam earlyversuslatesurgicalmanagementforcomplicatedappendicitisinadultsamulticenterpropensityscorematchingstudy |