Title: Research question : Morbidity of appendectomy ?? ??????? appendicitis ???????????????? ?????????? ????????????????????????????????????????? ???????????????????????
1Research question Morbidity of appendectomy
?? ??????? appendicitis ?????????????????????????
? ?????????????????????????????????????????
???????????????????????
- ???.??????? ???????? 42460055
- ???.?????? ???????? 42460154
- ???.?????? ????? 42460576
2??????????
- ?????????????????????????? 30
??????????????????????????? 1 ??
??????????????????????????????????????????????????
?????? ???????????????????????????????????????????
????????????? ????????????????????????????????????
?????????????????????????????????
??????????????????? ??????????????????????????
???????????????????????????????????????? 8 ????
??????????????????????????????????????????????????
??????????????????????????????????????????????????
????????????? ?????????????????????????????????
?????????????????????????????????????????????????
3??????? ??????
- Appendectomy ??????????????????????
????????????????????????????? ????????????????????
???????????????????????????????
???????????????????????????? ???
?????????????????(surgical wound infection) ????
?????????????????? (intra-abdominal abscess)
??????????????????????????????????????????????????
???????????????????????????? ?????????????????????
??????????????????????????????????????????????????
??????????????????????????????????????????????????
?? ???????????????????????????????????????????????
???
41.Reviews and Research questions
- 1.1 Consult with expert
- 1.2 Review of literature
- -Mortality after appendectomy in
Sweden,1987-1996. - Paul G. Blomqvist et al,2001/Annal of Surgery
- -Standardized patient care guidelines reduce
infectious morbidity in appendectomy patients. - Kenneth S. Helmer et al./The American Journal of
Surgery 183(2002)
5- Mortality after appendectomy in
Sweden,1987-1996. - Paul G. Blomqvist et al,2001/Annal of Surgery
- ????? mortality after appendectomy ???????
cohort study(prospective) ??????????? follow up
?????????? 30 ??? ??????? admit ?? case
??????????????????? ?????????????
????,???,discharge diagnosis,underlying cause of
death,and the time of death after admission ????
case??????????????????????????? ???? , ???
,underlying cause of abdominal pain - ??????????? 2.44/1000 ?? ??????????????????
?????? 0-9 ?? ??????? 0.31,20-29 ?? ???????
0.07,nonagenarians 164 ???????????????????????????
??????????????????????????????????????????????????
? 0.8/1000 ?? ??????????????????????????
5.1/1000?? ???????????????????????????????????????
???????????????????1.9/1000 ?? ??? 10/1000 ??
?????????????????????????????
6- Standardized patient care guidelines reduce
infectious morbidity in appendectomy patients. - Kenneth S. Helmer et al,2002/The American Journal
of Surgery 183 - -at the Lyndon Baines Johnson County Hospital in
Houston,Texas. - -retrospective Jan 1,1998 - Dec 31,1998
- -prospective Jan 1,1999 - Dec 31,1999
- -no exclusion criteria
- -?????????????????????????????????????????????,??
?,?????????????????????????????????????????????,??
??????????????,???????????????????????????????,???
??????????????????????, intraoperative and
pathologic finding,????????????????????-??????????
,????????????????????????????????,?????????????,??
???????????????????????????????
7- -?? simple appendicitis nonprotocol ??
infectious complication 2 - protocol ?? infectious complication
2 - -?? perforated or gangrenous appendix
- nonprotocol ?? infectious complication 33
- protocol ?? infectious complication
13
8(No Transcript)
9Results of the review
- Research question
- ????????? Morbidity of appendectomy ?? acute
appendicitis ??????????????????????????
?????????????????????????????????????????
??????????????????????? - ???????? ???????????????????
??????????????????????????????????????????????????
????????????? ??????? appendicitis ??????????????
102.Objective
- 1. ???????????????????????????????????????????????
?????????????????????????????? ????????
????????????????????????????????? - 2. ??????????????????????????????????
appendicitis ????????????????????? ????????
???????????????????????????????????????????? - 3. ???????????????????????????????????????????????
?????????? ??????????????????????????
113.Expected outcome
- 1. ???????????????????????????????????????????
???????????????????????????????????????????????
???????????????????????? - 2. ???????????????????????????????????????????????
??????????????????????????????????????????????????
?????????? acute appendicitis
124. Study design
- Observation
- Analytical (comparative)
- Retrospective
134.1 ???????????????(target population)
- Inclusion criteria
- ????????????????????????? appendectomy
????????????????????? ????????????????????????????
????????????? ??????????????? 1 ?.?.44 - 30
?.?.45
- Exclusion criteria
- ?????????????????????? 5 ??
- ???????????????????????????????????????????? ????
?????????????
144.2 ????????????????????(study population)????????
?????????????????(sampling technique)
- Non-probability sampling (????????????????????????
??????? - ?????????????)
154.3 ???????????? (sample size)
- Two independent group
- N/group Za/2 /p2(1-p2) ZB
/p1(1-p1)p2(1-p2)2 - Za Z-statistics for confidence interval
- P Prevalence
-
(p1-p2)2
16- Za/2 1.96 , ZB 1.28
- sample size P Prevalence P1 ?????????
morbidity ??????? treatment 0.13
P2 ????????? morbidity ??????? control 0.33 - ??????????? N 104.04 (???????????????????
??? perforated appendix) - ?????????????????????????????????????????
perforated appendix ?????????? 19.4 ??????????
appendicitis ??????? - ????????????????????????????????????? sample size
??????? 100 104.04 536. 2886
19.4
175.????????????????????????????????
- 5.1 ??????(variables)
- Dependent variable wound infection
,intraabdominal abscess - Independent variable simple appendicitis
- perforated or gangrenous appendix
- surgery time
- antibiotic
- surgical equipment
- Confounding variable experience of surgeon
18- 5.2 ??????????(precision)
- 5.2.1 Operational definitions
- Morbidity ????????????????????
???????????(surgical wound infection)
,??????????????????(intra-abdominal abscess)
,???????????????????? - surgical wound infection ????????????????????
????????(purulent drainage) ,?????????????(celluli
tis)??????????????????????? ,?????????????????????
??????????? - intra-abdominal abscess ??????????????????????
?????????? ????????????????? - perforated appendix ??????????????????????????
?????????(hole in the appendix)
,?????????????????????????????( free fluid in the
abdomen or an abscess cavity) - .
19- gangrenous appendix ??????????????????????????
???????????????????????(the gross appearance of
necrosis involving the appendix) - 5.2.2 Inter and intra-observer variations
-
- 5.3 Accuracy ( ??????????? )
- ??????????????????????????????? ????????nurse
note ???progress note , order sheets ???????????
medical record
206.Quality assurance ( ??????????????? )
- Data supervision data editing
7. Data analysis ( ?????????????????? )
21Result
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23(No Transcript)
24(No Transcript)
25(No Transcript)
26Preoperative patient characteristics
mean age (years)
P 0.53
P 0.95
P 0.15
27Preoperative patient characteristics
duration of symptoms (hours)
P 0.14
P 0.96
P 0.27
28P 0.68
29???????????????????????????????????
P 0.46
P 0.39
30Length of stay(mean) simple appendicitis
P 0.54
P 0.40
P 0.78
31Length of stay(mean) perforated,phregmon or
gangrenous appendix
P 0.75
P 0.35
P 0.58
32?????????????????????????????? Surgeon ???
Complication
P 0.78
P 0.40
P 0.38
33??????????????????????????????preoperative
antibiotic ??? complication
P 1.00
P 0.48
34Conclusion
- ??????????????????? ???????? ????????????????????
????????????? ????????????????????????????????????
??????????????????????????? ??????????????????????
?
35Discussion
- Selection bias study design
- choice of
sampling frame - loss to follow
up - Information bias incorrect diagnostic criteria
- Confounding bias age
-
underlying disease
36Suggestion
- ???????????????????????????????????????????
Prospective ??????????????????????????????????????
???????????? ?????????????? ? ??? - ???????????????????????????????????
????????????????? ???????????????????????
????????????????????????
37?????????????
- ???????? ???????????? . Appendix . ??
???????? ???????????? , ???? ????????? ,
?????????? . ?????????????? ( ????????????? 6 ).
???????? ????????????????????????????? , 2544
647 58 - ?????? ????????????? . ???????????????????????
???? 2 ,2545 - Rosemary A., Kozar and Joel J. Roslyn . The
Appendix. In Schwartz SI ,Shires GT , Spencer
FC , Husser WC, editors . Principles of
Surgery .7th edition. New York McGraw Hill ,
1999 1383 94 - Kenneth S. Helmer and the others. Standardized
patient care guidelines reduce infectious
morbidity in appendectomy patients The American
Journal of Surgery vol.83,2002 608-613 - Paul G. Blomqvist,PhD and others. Mortality after
appendectomy in Sweden,1987-1996 Annal of
Surgery,2001 465-470
38???????????
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