抗生素治疗对比阑尾切除术治疗单纯性急性阑尾炎7年随访的生活质量和患者满意度
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抗生素治疗对比阑尾切除术治疗单纯性急性阑尾炎7年随访的生活质量和患者满意度
翻译：冯玉蓉 编辑：冯玉蓉 审校：曹莹
重要性：长期研究结果支持抗生素作为阑尾切除术的一种替代方法治疗简单急性阑尾炎。但是，与治疗相关的长期患者满意度和生活质量（QOL）尚不清楚。
目的：探讨抗生素治疗和阑尾切除术治疗单纯性急性阑尾炎的患者满意度和生活质量。
干预措施：开腹阑尾切除术对比抗生素治疗，静脉注射厄他培南1g，每日一次，连续3天，然后口服左氧氟沙星500 mg，每日1次，甲硝唑500 mg，每天3次，连续7天。
设计、设置和参与者：本项急性阑尾炎（APAC）多中心随机临床试验的观察性随访，对阑尾切除术和抗生素治疗进行了比较，纳入530名年龄在18至60岁之间，经计算机断层扫描确诊的单纯性急性阑尾炎患者，并随机分为阑尾切除术组（273例（52%），或抗生素治疗组（257例（49%）。试验于2009年11月至2012年6月进行，最后一次随访时间为2018年5月9日。数据分析于2019年2月。
主要结果和检测指标：这项分析评估了干预后患者的生活质量（EQ-5D-5L）、患者满意度和首选治疗方式的次要结果。
在纳入试验的530名患者中，阑尾切除组273例（174例男性[64%],中位年龄35岁）；抗生素组257例（155例男性[60%],中位年龄33岁），423名患者（80%）接受电话随访，中位随访时间7年；206名患者（80%）服用抗生素，217名（79%）接受阑尾切除术。在206例服用抗生素的患者中，81例（39%）接受了阑尾切除术。阑尾切除术组和抗生素组患者的生活质量相似（健康指数中位数均为1.0；95%CI，0.86-1.0；P=0.96）。阑尾切除术患者对治疗的满意度高于抗生素组（阑尾切除术组68%非常满意，21%满意，6%一般，4%不满意，1%非常不满意；抗生素组53%非常满意，21%满意，13%一般，7%不满意，6%非常不满意；P<0.001）；在亚组分析中，这一差异是基于抗生素组接受阑尾切除术的患者。与阑尾切除术相比，使用抗生素成功治疗后患者满意度无差异（累积优势比[COR]为7.8；95%CI 0.5-1.3；P<0.36）。阑尾切除术患者或使用抗生素成功治疗的患者比抗生素组后来接受阑尾切除术的患者都更满意（COR 7.7；95%CI 4.6-12.9；P<0.001；COR 9.7；95%CI 5.4-15.3；P<0.001）。81例接受抗生素治疗的阑尾切除术患者中，有27例(33%)再次选择抗生素作为首选治疗。
结论和相关性：在本分析中，对于单纯性急性阑尾炎，阑尾切除术和抗生素治疗后的长期生活质量是相似的。服用抗生素治疗后又接受阑尾切除术的患者比使用抗生素成功治疗或阑尾切除术患者满意度更低。
原始文献来源：Sippola S, Haijanen J, Viinikainen L, et al. Quality of Life and Patient Satisfaction at 7-Year Follow-up of Antibiotic Therapy vs Appendectomy for Uncomplicated Acute Appendicitis: A Secondary Analysis of a Randomized Clinical Trial.[J]. JAMA Surg 2020 Apr 01;1554(4).DOI：10.1001/jamasurg.2019.6028 .
Quality of Life and Patient Satisfaction at 7-Year Follow-up of Antibiotic Therapy vs Appendectomy for Uncomplicated Acute Appendicitis
IMPORTANCE Long-term results support antibiotics for uncomplicated acute appendicitis as an alternative to appendectomy. To our knowledge, treatment-related long-term patient satisfaction and quality of life (QOL) are not known.
OBJECTIVE To determine patient satisfaction and QOL after antibiotic therapy and appendectomy for treating uncomplicated acute appendicitis.
INTERVENTIONS Open appendectomy vs antibiotics with intravenous ertapenem, 1g once daily, for 3 days followed by 7 days of oral levofloxacin, 500 mg once daily, and metronidazole, 500 mg 3 times per day.
DESIGN, SETTING, AND PARTICIPANTS This observational follow-up of the Appendicitis Acuta (APPAC) multicenter randomized clinical trial comparing appendectomy with antibiotics included 530 patients age 18 to 60 years with computed tomography–confirmed uncomplicated acute appendicitis who were randomized to undergo appendectomy (273 [52%]) or receive antibiotics (257 [49%]). The trial was conducted from November 2009 to June 2012; the last follow-up was May 9, 2018. The data were analyzed in February 2019.
MAIN OUTCOMES AND MEASURES In this analysis, post hoc secondary end points of postintervention QOL (EQ-5D-5L) and patient satisfaction and treatment preference were evaluated.
RESULTS Of the 530 patients enrolled in the trial (appendectomy group: 273 [174 men (64%)] with a median age of 35 years; (antibiotic group: 257 [155 men (60%)] with a median age of 33 years), 423 patients (80%) were available for phone interview at a median follow-up of 7 years; 206 patients (80%) took antibiotics and 217 (79%) underwent appendectomy. Of the 206 patients taking antibiotics, 81 (39%) had undergone appendectomy. The QOL between appendectomy and antibiotic group patients was similar (median health index value, 1.0 in both groups; 95% CI, 0.86-1.0; P = .96). Patients who underwent appendectomy were more satisfied in the treatment than patients taking antibiotics (68% very satisfied, 21% satisfied, 6% indifferent, 4% unsatisfied, and 1% very unsatisfied in the appendectomy group and 53% very satisfied, 21% satisfied, 13% indifferent, 7% unsatisfied, and 6% very unsatisfied in the antibiotic group; P< .001) and in a subgroup analysis this difference was based on the antibiotic group patients undergoing appendectomy. There was no difference in patient satisfaction after successful antibiotic treatment compared with appendectomy (cumulative odds ratio [COR], 7.8; 95% CI, 0.5-1.3; P< .36). Patients with appendectomy or with successful antibiotic therapy were more satisfied than antibiotic group patients who later underwent appendectomy (COR, 7.7; 95% CI, 4.6-12.9; P < .001; COR, 9.7; 95% CI, 5.4-15.3; P < .001, respectively). Of the 81 patients taking antibiotics who underwent appendectomy, 27 (33%) would again choose antibiotics as their primary treatment.
CONCLUSIONS AND RELEVANCE In this analysis, long-term QOL was similar after appendectomy and antibiotic therapy for the treatment of uncomplicated acute appendicitis. Patients taking antibiotics who later underwent appendectomy were less satisfied than patients with successful antibiotics or appendectomy.
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