Usefulness of Preoperative Predictors of Pathological Complicated Appendicitis.

IF 1.8 3区 医学 Q3 GASTROENTEROLOGY & HEPATOLOGY Digestive Surgery Pub Date : 2023-01-01 DOI:10.1159/000531284
Masahiro Shiihara, Yasuhiro Sudo, Norimasa Matsushita, Takeshi Kubota, Yasuhiro Hibi, Harushi Osugi, Tatsuo Inoue
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Abstract

Introduction: Complicated appendicitis (CA) is often indicated for emergency surgery; however, preoperative predictors of pathological CA (pCA) remain unclear. Furthermore, characteristics of CA that can be treated conservatively have not yet been established.

Methods: 305 consecutive patients diagnosed with acute appendicitis were reviewed. The patients were divided into two groups: an emergency surgery and a conservative treatment group. The emergency surgery group was pathologically classified as having uncomplicated appendicitis (pUA) and pCA, and the preoperative predictors of pCA were retrospectively assessed. Based on the preoperative pCA predictors, a predictive nomogram whether conservative treatment would be successful or not was created. The predictors were applied to the conservative treatment group, and the outcomes were investigated.

Results: In the multiple logistic regression analysis of the factors contributing to pCA, C-reactive protein ≥3.5 mg/dL, ascites, appendiceal wall defect, and periappendiceal fluid collection were independent risk factors. Over 90% of cases without any of the above four preoperative pCA predictors were pUA. The accuracy of the nomogram was 0.938.

Conclusion: Our preoperative predictors and nomogram are useful to aid in distinguishing pCA and pUA and to predict whether or not conservative treatment will be successful. Some CA can be treated with conservative treatment.

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病理性复杂性阑尾炎术前预测因子的有效性。
简介:复杂性阑尾炎(CA)常指急诊手术;然而,病理性CA (pCA)的术前预测因素尚不清楚。此外,可以保守治疗的CA的特征尚未确定。方法:回顾性分析305例急性阑尾炎患者的临床资料。患者分为两组:紧急手术组和保守治疗组。急诊手术组病理分类为无并发症阑尾炎(pUA)和pCA,回顾性评估pCA术前预测因素。基于术前pCA预测因子,建立保守治疗成功与否的预测图。将预测因子应用于保守治疗组,并观察预后。结果:在对pCA影响因素的多元logistic回归分析中,c反应蛋白≥3.5 mg/dL、腹水、阑尾壁缺损、阑尾周围积液是独立的危险因素。术前无上述四种pCA预测因子的病例中,超过90%为pUA。图的准确度为0.938。结论:我们的术前预测指标和形态图有助于区分pCA和pUA,并预测保守治疗是否成功。有些CA可以保守治疗。
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来源期刊
Digestive Surgery
Digestive Surgery 医学-外科
CiteScore
4.90
自引率
3.70%
发文量
25
审稿时长
3 months
期刊介绍: ''Digestive Surgery'' presents a comprehensive overview in the field of gastrointestinal surgery. Interdisciplinary in scope, the journal keeps the specialist aware of advances in all fields that contribute to improvements in the diagnosis and treatment of gastrointestinal disease. Particular emphasis is given to articles that evaluate not only recent clinical developments, especially clinical trials and technical innovations such as new endoscopic and laparoscopic procedures, but also relevant translational research. Each contribution is carefully aligned with the need of the digestive surgeon. Thus, the journal is an important component of the continuing medical education of surgeons who want their practice to benefit from a familiarity with new knowledge in all its dimensions.
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