The effectiveness of emergency surgery vs. non-emergency surgery strategies for emergency admissions with acute appendicitis, gallstone disease, diverticular disease, abdominal wall hernia or intestinal obstruction is unknown. Data on emergency admissions for adult patients from 2010 to 2019 at 175 acute National Health Service hospitals in England were extracted from the Hospital Episode Statistics database. Cohort sizes were: 268,144 (appendicitis); 240,977 (gallstone disease); 138,869 (diverticular disease); 106,432 (hernia); and 133,073 (intestinal obstruction). The primary outcome was number of days alive and out of hospital at 90 days. The effectiveness of emergency surgery vs. non-emergency surgery strategies was estimated using an instrumental variable design and is reported for the cohort and pre-specified sub-groups (age, sex, number of comorbidities and frailty level). Average days alive and out of hospital at 90 days for all five cohorts were similar, with the following mean differences (95%CI) for emergency surgery minus non-emergency surgery after adjusting for confounding: −0.73 days (−2.10–0.64) for appendicitis; 0.60 (−0.10–1.30) for gallstone disease; −2.66 (−15.7–10.4) for diverticular disease; −0.07 (−2.40–2.25) for hernia; and 3.32 (−3.13–9.76) for intestinal obstruction. For patients with ‘severe frailty’, mean differences (95%CI) in days alive and out of hospital for emergency surgery were lower than for non-emergency surgery strategies: −21.0 (−27.4 to −14.6) for appendicitis; −5.72 (−11.3 to −0.2) for gallstone disease, −38.9 (−63.3 to −14.6) for diverticular disease; −19.5 (−26.6 to −12.3) for hernia; and − 34.5 (−46.7 to −22.4) for intestinal obstruction. For patients without frailty, the mean differences (95%CI) in days alive and out of hospital were: −0.18 (−1.56–1.20) for appendicitis; 0.93 (0.48–1.39) for gallstone disease; 5.35 (−2.56–13.28) for diverticular disease; 2.26 (0.37–4.15) for hernia; and 18.2 (14.8–22.47) for intestinal obstruction. Emergency surgery and non-emergency surgery strategies led to similar average days alive and out of hospital at 90 days for five acute conditions. The comparative effectiveness of emergency surgery and non-emergency surgery strategies for these conditions may be modified by patient factors.

中文翻译：

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五种常见急性疾病急诊手术的有效性：国家常规数据库的工具变量分析

对于急性阑尾炎、胆结石病、憩室病、腹壁疝或肠梗阻的急诊入院，急诊手术与非急诊手术策略的有效性尚不清楚。从医院事件统计数据库中提取了 2010 年至 2019 年英格兰 175 家急性国民健康服务医院的成人患者急诊入院数据。队列规模为：268,144（阑尾炎）；240,977（胆结石病）；138,869（憩室病）；106,432（疝气）；和 133,073（肠梗阻）。主要结果是 90 天时存活和出院的天数。使用工具变量设计估计急诊手术与非急诊手术策略的有效性，并针对队列和预先指定的亚组（年龄、性别、合并症的数量和虚弱程度）。所有五个队列在 90 天时的平均存活天数和出院天数相似，在调整混杂因素后，紧急手术减去非紧急手术的平均差异如下 (95%CI)：-0.73 天 (-2.10-0.64)阑尾炎; 0.60 (-0.10–1.30) 用于胆结石病；-2.66 (-15.7–10.4) 用于憩室病；-0.07 (-2.40–2.25) 用于疝气；肠梗阻为 3.32 (-3.13–9.76)。对于“严重虚弱”的患者，急诊手术的存活天数和出院天数的平均差异 (95%CI) 低于非急诊手术策略：阑尾炎为 -21.0（-27.4 至 -14.6）；-5.72（-11.3 至 -0.2）用于胆结石病，-38.9（-63.3 至 -14.6）用于憩室病；疝气 -19.5（-26.6 至 -12.3）；- 34.5（-46.7 至 -22。4）用于肠梗阻。对于没有虚弱的患者，存活天数和出院天数的平均差异 (95%CI) 为：-0.18 (-1.56-1.20) 为阑尾炎；0.93 (0.48–1.39) 用于胆结石病；5.35 (-2.56–13.28) 用于憩室病；2.26 (0.37–4.15) 用于疝气；和 18.2 (14.8–22.47) 用于肠梗阻。紧急手术和非紧急手术策略导致五种急性疾病的平均存活天数和出院天数相似，为 90 天。针对这些情况的急诊手术和非急诊手术策略的比较有效性可能会因患者因素而有所改变。15) 用于疝气；和 18.2 (14.8–22.47) 用于肠梗阻。紧急手术和非紧急手术策略导致五种急性疾病的平均存活天数和出院天数相似，为 90 天。针对这些情况的急诊手术和非急诊手术策略的比较有效性可能会因患者因素而有所改变。15) 用于疝气；和 18.2 (14.8–22.47) 用于肠梗阻。紧急手术和非紧急手术策略导致五种急性疾病的平均存活天数和出院天数相似，为 90 天。针对这些情况的急诊手术和非急诊手术策略的比较有效性可能会因患者因素而有所改变。