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Management der akuten Appendizitis

Evidenz für eine zeitnahe chirurgische Therapie?

Management of acute appendicitis

Evidence for prompt surgical treatment?

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Zusammenfassung

Hintergrund

Die akute Appendizitis ist eine häufige Erkrankung und bedarf einer zeitnahen chirurgischen Therapie des entzündlichen Fokus. Bisher gibt es jedoch keine verlässlichen Daten, wie viel Zeit zwischen Aufnahme des Patienten in die Klinik, Indikation zur Operation und chirurgischer Therapie ohne ein erhöhtes Morbiditäts- und Mortalitätsrisiko für den Patienten vergehen darf.

Fragestellung

Diese Arbeit untersucht monozentrisch den Grenzwert, wie viel Zeit bis zur Durchführung einer Appendektomie vergehen darf, ohne dass dem Patienten ein Schaden entsteht.

Material und Methoden

In dieser retrospektiven Studie wurde das Management aller Patienten analysiert, die unter dem Verdacht auf eine akute Appendizitis operiert wurden. Neben der Zeitdauer zwischen der Aufnahme in die Klinik und Operationsbeginn (Aufnahme-Schnitt-Dauer, ASD) wurden anamnestische, diagnostische, chirurgisch-technische und perioperative Daten erhoben und statistisch analysiert (Mittelwert ± Standardabweichung).

Ergebnisse

Von 01/2008 bis 04/2013 wurden 655 Patienten appendektomiert. Die mediane ASD betrug genau 7 h. Die negative Appendektomierate betrug 9,8 %. Im Durchschnitt verbrachten die Patienten 5,9 ± 8,7 Tage in der Klinik mit einer postoperativen Verweildauer von 5,2 ± 7,1 Tage. Der Vergleich der Patientenkollektive, aufgeschlüsselt nach zunehmender ASD, zeigte, dass bis zu einer ASD von 8 h keine gesteigerte Wahrscheinlichkeit für das Vorhandensein einer Perforation oder einer postoperativen Komplikation vorlag.

Diskussion

Diese retrospektive Kohortenanalyse zeigt, dass die Durchführung der Appendektomie in den ersten 8 h nach Aufnahme des Patienten in die Klinik erfolgen sollte.

Abstract

Background

Acute appendicitis is a common disease which requires immediate surgical treatment of the focus of inflammation. So far there are no reliable data on how much time can pass between hospitalization, indications for surgery and initiating surgery without an increased risk of morbidity and mortality for the patient.

Objective

The aim of this study was to investigate how much time can lapse between admission and initiation of surgery for acute appendicitis while still providing patient safety and no increase in complication rates.

Material and methods

This retrospective analysis investigated the management of all patients who underwent appendectomy under the suspicion of acute appendicitis. Besides the time span between hospital admittance and beginning of the operation (admission to incision time, AIT), anamnestic, diagnostic, technical and perioperative data were assessed and statistically analyzed (mean ± SD).

Results

From January 2008 to April 2013 a total of 655 patients underwent appendectomy. The mean AIT was 7 h and the rate of negative appendectomy was 9.8 %. The mean hospitalization period was 5.9 ± 8.7 days with a postoperative stay of 5.2 ± 7.1 days. A comparison of the subgroups stratified by increasing AIT showed that there was no increased probability for perforation or postoperative complications with an AIT of up to 8 h.

Discussion

This retrospective cohort study showed that appendectomy should be performed within the first 8 h after hospitalization of the patient.

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Correspondence to J. E. Slotta MD, PhD.

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Interessenkonflikt

J.E. Slotta, U. Kopsch, M. Ghadimi und O. Kollmar geben an, dass kein Interessenkonflikt besteht.

Sämtliche ethischen Normen im Zusammenhang mit dieser retrospektiven Datenanalyse wurden geachtet, eine Bewilligung zur Durchführung der Studie durch das örtliche Ethikkommitee liegt vor. Es wurden keine Studien an Menschen durchgeführt.

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Slotta, J.E., Kopsch, U., Ghadimi, M. et al. Management der akuten Appendizitis. Chirurg 88, 503–511 (2017). https://doi.org/10.1007/s00104-016-0310-2

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