Correlation Between Intraoperative Surgical Diagnosis of Complicated Acute Appendicitis and the Pathology Report: Clinical Implications

Correa, Jessica; Jimeno, Jaime; Vallverdú, Helena; Bizzoca, Cinzia; Collado-Roura, Francesc; Estalella, Laia; Hermoso, Judith; Silva, Natália; Sánchez-Pradell, Cristina; Parés, David

doi:10.1089/sur.2013.155

Cited by 25 publications

(17 citation statements)

References 12 publications

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“…In this study, there were discrepancies between the surgical and pathologic diagnoses of appendicitis, which is an occasionally reported condition [267]. The clinical significance of these findings remains unclear.…”

Section: Discussionmentioning

confidence: 81%

“…Today, in developed countries, approximately 8% of the population has undergone appendectomy for acute appendicitis during their lifetime [1]. Although the severity of acute appendicitis is defined and classified by both surgeons and pathologists, the postoperative management depends primarily on the surgeons' intraoperative findings [2]. As the diagnosis made by pathologists is typically decided several days after the operation, it usually does not influence the patients' postoperative management unless the diagnosis is an abnormality other than inflammatory change [3].…”

Section: Introductionmentioning

confidence: 99%

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Clinical implication of discrepancies between surgical and pathologic diagnoses of acute appendicitis

et al. 2017

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PurposeThe postoperative treatment after appendectomy is usually decided on the basis of the surgeons' intraoperative findings. Comparatively, the pathologic diagnosis of appendicitis is confirmed several days after the surgery; therefore, it usually does not affect the postoperative treatment strategy. The aim of this study was to investigate the discrepancies between the surgical and pathologic diagnoses of appendicitis and to identify their clinical implication.MethodsA retrospective observational study was performed in 1,817 patients who underwent 3-port laparoscopic appendectomy for the final diagnosis of appendicitis. The clinical variables that could estimate the severity of appendicitis and the intensity of postoperative treatment were analyzed and compared according to the surgical and pathologic diagnoses.ResultsOf 1,321 cases of surgically simple appendicitis, 254 (29.3%) were pathologically complicated appendicitis. On the other hand, 221 of 496 cases (44.5%) of surgically complicated appendicitis were pathologically simple. Neither the surgical nor the pathologic diagnosis of appendicitis affected the development of postoperative intra-abdominal abscess (P = 0.079 for surgical diagnosis; P = 0.288 for pathologic diagnosis); however, the surgical diagnosis showed more correlation with the severity of disease and the intensity of the treatment pathway than did the pathologic diagnosis.ConclusionThere were discrepancies between the surgeons' intraoperative assessment and the pathologists' final histologic diagnosis of appendicitis. The surgeon's classification might be more predictive of the outcome than the pathologist's because only the surgeon's findings are available immediately after surgery.

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Section: Discussionmentioning

confidence: 81%

Section: Introductionmentioning

confidence: 99%

Clinical implication of discrepancies between surgical and pathologic diagnoses of acute appendicitis

et al. 2017

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“…Clinical follow-up consisted of observation in the emergency department until an alternative diagnosis explaining the child's pain was established or the child was pain-free and tolerating food. Although the operative diagnosis and pathological diagnosis of appendicitis frequently differ, we used the operative diagnosis for statistical analyses because it has been shown to better predict the postoperative course [13,14]. Recorded US features were correlated with reference standards of operative diagnosis or clinical followup by multivariate analysis via logistic regression using Statistical Analysis System 9.3 (SAS Institute Inc., Cary, NC).…”

Section: Methodsmentioning

confidence: 99%

Searching for certainty: findings predictive of appendicitis in equivocal ultrasound exams

et al. 2016

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Loss of mural stratification, peri-appendiceal fat inflammation and an appendicolith are significant predictors of appendicitis in children with otherwise equivocal US exams. While maximum appendiceal diameter is not statistically associated with appendicitis in our study, mean appendiceal diameter of 6.7 mm in those without appendicitis suggests that the customary upper normal limit of 6 mm is too sensitive.

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“…In this classification, a phlegmonous appendix is considered simple appendicitis, whereas gangrenous appendicitis, perforated appendicitis and periappendiceal abscess formation are regarded as complex appendicitis. Previous studies have shown that the intraoperative assessment of the appendix frequently does not concur with the histopathological assessment. Intraoperative findings were found to be more predictive of the postoperative course (complications) than the histopathological classification.…”

Section: Introductionmentioning

confidence: 98%

Interobserver variability in the classification of appendicitis during laparoscopy

Boom

Wijkerslooth

Mauff

et al. 2018

British Journal of Surgery

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BackgroundThe intraoperative classification of appendicitis dictates the patient's postoperative management. Prolonged antibiotic prophylaxis is recommended for complex appendicitis (gangrenous, perforated, abscess), whereas preoperative prophylaxis suffices for simple appendicitis. Distinguishing these two conditions can be challenging. The aim of this study was to assess interobserver variability in the classification of appendicitis during laparoscopy.MethodsShort video recordings taken during laparoscopy for suspected appendicitis were shown to surgeons and surgical residents. They were asked to: classify the appendix as indicative of no, simple or complex appendicitis; categorize the appendix as normal, phlegmonous, gangrenous, perforated and/or abscess; and decide whether they would prescribe postoperative antibiotics. Inter‐rater reliability was evaluated using Fleiss' κ score and the S* statistic.ResultsSome 80 assessors participated in the study. Video recordings of 20 patients were used. Interobserver agreement was minimal for both the classification of appendicitis (κ score 0·398, 95 per cent c.i. 0·385 to 0·410) and the decision to prescribe postoperative antibiotic treatment (κ score 0·378, 0·362 to 0·393). Agreement was slightly higher when published criteria were applied (κ score 0·552, 0·537 to 0·568).ConclusionThere is considerable variability in the intraoperative classification of appendicitis and the decision to prescribe postoperative antibiotic treatment.

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Correlation Between Intraoperative Surgical Diagnosis of Complicated Acute Appendicitis and the Pathology Report: Clinical Implications

Abstract: We found a weak correlation between the surgeon's macroscopic diagnosis and the pathologic findings. However, the differences did not have meaningful clinical implications. Further studies are required to evaluate the clinical meaning of these results.

Cited by 25 publications

References 12 publications

Clinical implication of discrepancies between surgical and pathologic diagnoses of acute appendicitis

Clinical implication of discrepancies between surgical and pathologic diagnoses of acute appendicitis

Searching for certainty: findings predictive of appendicitis in equivocal ultrasound exams

Interobserver variability in the classification of appendicitis during laparoscopy

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