Research question : Morbidity of appendectomy ?? ??????? appendicitis ???????????????? ?????????? ????????????????????????????????????????? ??????????????????????? - PowerPoint PPT Presentation

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Research question : Morbidity of appendectomy ?? ??????? appendicitis ???????????????? ?????????? ????????????????????????????????????????? ???????????????????????

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Title: Research question : Morbidity of appendectomy ?? ??????? appendicitis ???????????????? ?????????? ????????????????????????????????????????? ???????????????????????


1
Research question Morbidity of appendectomy
?? ??????? appendicitis ?????????????????????????
? ?????????????????????????????????????????
???????????????????????
  • ???.??????? ???????? 42460055
  • ???.?????? ???????? 42460154
  • ???.?????? ????? 42460576

2
??????????
  • ?????????????????????????? 30
    ??????????????????????????? 1 ??
    ??????????????????????????????????????????????????
    ?????? ???????????????????????????????????????????
    ????????????? ????????????????????????????????????
    ?????????????????????????????????
    ??????????????????? ??????????????????????????
    ???????????????????????????????????????? 8 ????
    ??????????????????????????????????????????????????
    ??????????????????????????????????????????????????
    ????????????? ?????????????????????????????????
    ?????????????????????????????????????????????????

3
??????? ??????
  • Appendectomy ??????????????????????
    ????????????????????????????? ????????????????????
    ???????????????????????????????
    ???????????????????????????? ???
    ?????????????????(surgical wound infection) ????
    ?????????????????? (intra-abdominal abscess)
    ??????????????????????????????????????????????????
    ???????????????????????????? ?????????????????????
    ??????????????????????????????????????????????????
    ??????????????????????????????????????????????????
    ?? ???????????????????????????????????????????????
    ???

4
1.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

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9
Results of the review
  • Research question
  • ????????? Morbidity of appendectomy ?? acute
    appendicitis ??????????????????????????
    ?????????????????????????????????????????
    ???????????????????????
  • ???????? ???????????????????
    ??????????????????????????????????????????????????
    ????????????? ??????? appendicitis ??????????????

10
2.Objective
  • 1. ???????????????????????????????????????????????
    ?????????????????????????????? ????????
    ?????????????????????????????????
  • 2. ??????????????????????????????????
    appendicitis ????????????????????? ????????
    ????????????????????????????????????????????
  • 3. ???????????????????????????????????????????????
    ?????????? ??????????????????????????

11
3.Expected outcome
  • 1. ???????????????????????????????????????????
    ???????????????????????????????????????????????
    ????????????????????????
  • 2. ???????????????????????????????????????????????
    ??????????????????????????????????????????????????
    ?????????? acute appendicitis

12
4. Study design
  • Observation
  • Analytical (comparative)
  • Retrospective

13
4.1 ???????????????(target population)
  • Inclusion criteria
  • ????????????????????????? appendectomy
    ????????????????????? ????????????????????????????
    ????????????? ??????????????? 1 ?.?.44 - 30
    ?.?.45
  • Exclusion criteria
  • ?????????????????????? 5 ??
  • ???????????????????????????????????????????? ????
    ?????????????

14
4.2 ????????????????????(study population)????????
?????????????????(sampling technique)
  • Non-probability sampling (????????????????????????
    ???????
  • ?????????????)

15
4.3 ???????????? (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

17
5.????????????????????????????????
  • 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

20
6.Quality assurance ( ??????????????? )
  • Data supervision data editing

7. Data analysis ( ?????????????????? )
  • Chi-square test

21
Result
22
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26
Preoperative patient characteristics
mean age (years)
P 0.53
P 0.95
P 0.15
27
Preoperative patient characteristics
duration of symptoms (hours)
P 0.14
P 0.96
P 0.27
28
P 0.68
29
???????????????????????????????????
P 0.46
P 0.39
30
Length of stay(mean) simple appendicitis
P 0.54
P 0.40
P 0.78
31
Length 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
34
Conclusion
  • ??????????????????? ???????? ????????????????????
    ????????????? ????????????????????????????????????
    ??????????????????????????? ??????????????????????
    ?

35
Discussion
  • Selection bias study design
  • choice of
    sampling frame
  • loss to follow
    up
  • Information bias incorrect diagnostic criteria
  • Confounding bias age

  • underlying disease

36
Suggestion
  • ???????????????????????????????????????????
    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
???????????
  • ??????????????resident ???????????????????????????
    ???? ???????????????????????????????????????????
    ?????????????????????????
  • ??????????????????????????????????????????????????
    ???????????????????????????????
  • ????????????????????????????
  • ??????????? ?????? ????????????????????????????
    ????????????????????
  • ???????????????? ???????????? ????????????????????
    ???????????????????????? , ???????????
    ??????????????????????????????????????????????????
    ?????????????????????????????????????????????????
    ???
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