Meta-analysis of unplanned readmission to hospital post-appendectomy: an opportunity for a new benchmark.

Autor: Bailey K; Donegal Clinical and Research Academy, Letterkenny University Hospital, Letterkenny, Ireland., Choynowski M; Donegal Clinical and Research Academy, Letterkenny University Hospital, Letterkenny, Ireland., Kabir SMU; Donegal Clinical and Research Academy, Letterkenny University Hospital, Letterkenny, Ireland.; Department of Surgery, Letterkenny University Hospital, Letterkenny, Ireland., Lawler J; Donegal Clinical and Research Academy, Letterkenny University Hospital, Letterkenny, Ireland., Badrin A; Donegal Clinical and Research Academy, Letterkenny University Hospital, Letterkenny, Ireland., Sugrue M; Donegal Clinical and Research Academy, Letterkenny University Hospital, Letterkenny, Ireland.; Department of Surgery, Letterkenny University Hospital, Letterkenny, Ireland.; EU INTERREG Centre for Personalised Medicine Project, Intelligent Systems Research Centre, School of Computing, Engineering and Intelligent Systems, Ulster University, Magee Campus, Londonderry, Northern Ireland.
Jazyk: angličtina
Zdroj: ANZ journal of surgery [ANZ J Surg] 2019 Nov; Vol. 89 (11), pp. 1386-1391. Date of Electronic Publication: 2019 Jul 30.
DOI: 10.1111/ans.15362
Abstrakt: Background: Appendicitis is the most common cause of acute abdominal pain requiring surgical intervention. While many studies report readmission, a meta-analysis of readmission post-appendectomy has not been published. This meta-analysis was undertaken to determine rates and predictors of hospital readmission following appendectomy and to potentially provide a metric benchmark.
Methods: An ethically approved PROSPERO-registered (ID CRD42017069040) meta-analysis following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, using databases PubMed and Scopus, was undertaken for studies published between January 2012 and June 2017. Articles relating to outcomes and readmissions after appendectomy were identified. Those scoring >15 for comparative studies and >10 for non-comparative studies, using Methodological Index for Non-Randomized Studies criteria were included in the final analysis. The odds ratios (OR) using random-effects, Mantel-Haenszel method with 95% confidence intervals (CI), were computed for each risk factor with RevMan5.
Results: A total of 1757 articles reviewed were reduced to 45 qualifying studies for a final analysis of 836 921 appendectomies. 4.3% (range 0.0-14.4%) of patients were readmitted within 30 days. Significant preoperative patient factors for increased readmission were diabetes mellitus (OR 1.93, CI 1.63-2.28, P < 0.00001), complicated appendicitis (OR 3.6, CI 2.43-5.34, P < 0.00001) and open surgical technique (OR 1.39, CI 1.08-1.79, P < 0.00001). Increased readmission was not associated with gender, obesity or paediatric versus general surgeons or centres.
Conclusion: This meta-analysis identified that readmission is not uncommon post-appendectomy, occurring in one in 25 cases. The mean readmission rate of 4.3% may act as a quality benchmark for improving emergency surgical care. Targeting high-risk groups with diabetes or complicated appendicitis and increasing use of laparoscopic technique may help reduce readmission rates.
(© 2019 Royal Australasian College of Surgeons.)
Databáze: MEDLINE
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