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  1. Pitfalls in nonrandomized outcomes studies : the case of incidental appendectomy with open cholecystectomy.

    Article - En anglais

    Objectives

    - To assess the short-term outcomes of incidental appendectomy through analysis of hospital administrative data and determine the consistency and plausibility of the observed results.

    Design

    - Population-based historical cohort study.

    Setting

    - All general hospitals in Ontario between 1981 and 1990.

    Patients

    - Patients undergoing open primary cholecystectomy with (7846 exposed) and without (191 599 unexposed) incidental appendectomy.

    Adverse effects from incidental appendectomy emerged consistently for all three outcomes only after restricting the analysis to subgroups of patients at low surgical risk.

    The increased mortality for exposed patients was largest among low-risk groups ; for example, among those younger than 70 years undergoing elective surgery, the OR was 2.65 (95% Cl, 1.25 to 5.64 ; P<. 001).

    Conclusion

    - These findings suggest that incidental appendectomy is associated with a small but definite increase in adverse postoperative outcomes.

    However, plausible and consistent findings were only obtained after restricting the analysis to low-risk subgroups in which unmeasured differences in patients'baseline characteristics were less likely to confound adjusted outcome comparisons.

    This exercise highlights the potential pitfalls in nonrandomized outcomes comparisons using data sources.

    Mots-clés Pascal : Biais méthodologique, Essai thérapeutique contrôlé, Valeur relative, Résultat, Chirurgie, Cholécystectomie, Laparotomie, Association, Appendicectomie, Complication, Iatrogène, Etude cas, Homme

    Mots-clés Pascal anglais : Methodological bias, Controlled therapeutic trial, Relative value, Result, Surgery, Cholecystectomy, Laparotomy, Association, Appendectomy, Complication, Iatrogenic, Case study, Human

    Logo du centre Notice produite par :
    Inist-CNRS - Institut de l'Information Scientifique et Technique

    Cote : 96-0040415

    Code Inist : 002B30A01A1. Création : 01/03/1996.