Perorālā un intravenozā antibakteriālā terapija un pēcoperācijas periods pēc apendektomijas sarežģīta apendicīta gadījumā
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Latvijas Universitāte
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lav
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Nosaukums: Perorāla pret intravenozu antibakteriālu terapiju pēcoperācijas periodā pēc apendektomijas sarežģītas apendicīta gadījumā. Ievads: Sarežģīts apendicīts ir bieža ķirurģiska neatliekamā situācija, kas bieži prasa apendektomiju un pēcoperācijas antibakteriālu terapiju. Tradicionāli antibiotikas tiek ievadītas intravenozi, taču nesen veikti pētījumi liecina, ka perorāla lietošana sniedz līdzvērtīgus rezultātus. Mērķis: Šī pētījuma mērķis ir uzlabot antibiotiku lietošanu pēcoperācijas aprūpē, iespējams, samazināt pēcoperācijas komplikāciju risku, sekmēt antibakteriālās terapijas nepārtrauktību pēc izrakstīšanas, uzlabot pacientu ārstēšanās rezultātus un samazināt veselības aprūpes izmaksas. Materiāli un metodes: Perspektīvs, randomizēts, kontrolēts, dubultakls pētījums, kurā tika analizēti 28 dalībnieki vecumā no 18 līdz 80 gadiem, kuriem tika veikta laparoskopiska vai McBurney iegrieziena apendektomija sarežģīta apendicīta dēļ. Pētījuma sākumā dalībnieki tika sadalīti divās grupās: pacienti, kuri saņēma perorālu antibakteriālu terapiju (11 pacienti), un pacienti, kuri saņēma intravenozu antibakteriālu terapiju (17 pacienti). Tika analizēts hospitalizācijas ilgums, komplikāciju biežums, iekaisuma rādītāji, pacientu apmierinātība un ārstēšanas izmaksas. Statistiskai analīzei tika izmantotas programmas SPSS 29.0 un Excel. Rezultāti: Gan perorālajā (PO), gan intravenozajā (IV) grupā visbiežākā komplikācija bija šķidra vēdera izeja. Vienam pacientam IV grupā komplikācijas izpaudās kā drudzis un sāpes labajā apakšējā kvadrantā, kas prasīja atkārtotu hospitalizāciju. PO grupai bija nedaudz īsāks hospitalizācijas ilgums salīdzinājumā ar IV grupu (PO = vidējais ranga 11,73; IV = 16,29), taču statistiski tas nebija nozīmīgi (p = 0,161). C-reaktīvā proteīna (CRP) līmenis izrakstīšanas brīdī abās grupās bija vienāds (vidējais rangs 8,50) un statistiski nenozīmīgs. Netika konstatēta statistiski nozīmīga saistība starp CRP un leikocītu skaitu (p = 1,00 un p = 0,098, attiecīgi). Visi pacienti bija apmierināti ar ārstēšanu, izņemot vienu pacientu IV grupā, kurš norādīja uz adatu bailēm. Perorālās terapijas ikdienas izmaksas bija būtiski zemākas nekā intravenozās (PO = 13,93 €; IV = 2,47 € attiecīgi). Secinājumi: Perorālā antibakteriālā terapija ir tikpat efektīva kā intravenozā terapija sarežģīta apendicīta pēcoperācijas komplikāciju mazināšanā un ir izmaksu ziņā izdevīgāka.
Title: Peroral versus intravenous antibacterial therapy in postoperative period after appendectomy for complicated appendicitis. Background: Complicated appendicitis is a common surgical emergency that frequently necessitates an appendectomy and requires antibiotic therapy postoperatively. Antibacterial therapy traditionally is administered intravenous but recently studies have shown that oral route provides the same effects. Objective: This study seeks to refine antibiotic use in postoperative care, potentially, reduce complications post surgery, help to provide continuity of antibacterial treatment after discharge, improving patient satisfaction, and reducing healthcare costs. Materials and methods: Prospective randomised controlled blinded trial that analyses 28 participants aged 18-80 years who underwent laparoscopic or McBurney incision appendectomy for complicated appendicitis. At the beginning of the research, two groups were created: patients receiving oral antibacterial therapy (11 patients) and patients receiving intravenous antibacterial therapy (17 patients). We analysed duration of hospitalization, complications incidence, inflammatory markers, patient satisfaction, cost of treatment. SPSS 29.0 program and excel was used for the statistical analysis. Results: In the peroral (PO) and intravenous (IV) group, loose stool was the most common complication. One patient in IV had fever with right lower quadrant pain as complication, requiring readmission. PO had slightly shorter hospitalisation length compared to IV (PO= mean rake 11.73, IV = 16.29), however it was not statistically significant (p = 0.161). C-reactive protein (CRP) levels at discharge were statistically insignificant with both having the same mean rank (8.50). There was no significant association found between CRP and leukocyte count (p=1.00 and p=0.098, respectively). All patients were satisfied with treatment but one patient from IV group due to fear of needles. Lastly, daily cost of PO was significantly lower than IV (PO = €13.93, IV= €2.47, respectively). Conclusion: Peroral administration is as effective as intravenous antibacterial treatment in reducing post-surgical complications and cost effective.
Title: Peroral versus intravenous antibacterial therapy in postoperative period after appendectomy for complicated appendicitis. Background: Complicated appendicitis is a common surgical emergency that frequently necessitates an appendectomy and requires antibiotic therapy postoperatively. Antibacterial therapy traditionally is administered intravenous but recently studies have shown that oral route provides the same effects. Objective: This study seeks to refine antibiotic use in postoperative care, potentially, reduce complications post surgery, help to provide continuity of antibacterial treatment after discharge, improving patient satisfaction, and reducing healthcare costs. Materials and methods: Prospective randomised controlled blinded trial that analyses 28 participants aged 18-80 years who underwent laparoscopic or McBurney incision appendectomy for complicated appendicitis. At the beginning of the research, two groups were created: patients receiving oral antibacterial therapy (11 patients) and patients receiving intravenous antibacterial therapy (17 patients). We analysed duration of hospitalization, complications incidence, inflammatory markers, patient satisfaction, cost of treatment. SPSS 29.0 program and excel was used for the statistical analysis. Results: In the peroral (PO) and intravenous (IV) group, loose stool was the most common complication. One patient in IV had fever with right lower quadrant pain as complication, requiring readmission. PO had slightly shorter hospitalisation length compared to IV (PO= mean rake 11.73, IV = 16.29), however it was not statistically significant (p = 0.161). C-reactive protein (CRP) levels at discharge were statistically insignificant with both having the same mean rank (8.50). There was no significant association found between CRP and leukocyte count (p=1.00 and p=0.098, respectively). All patients were satisfied with treatment but one patient from IV group due to fear of needles. Lastly, daily cost of PO was significantly lower than IV (PO = €13.93, IV= €2.47, respectively). Conclusion: Peroral administration is as effective as intravenous antibacterial treatment in reducing post-surgical complications and cost effective.