Interobserver variability in the classification of appendicitis during laparoscopy

Boom, Anne Loes van den; Wijkerslooth, Elisabeth M L de; Mauff, Katya; Dawson, I.; Rossem, Charles C. van; Toorenvliet, Boudewijn R.; Wijnhoven, Bas P. L.

doi:10.1002/bjs.10837

Cited by 31 publications

(22 citation statements)

References 35 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In 2018, a survey among Dutch surgeons demonstrated that a clear standard of care is missing both in patient selection and in determining the length of antibiotic treatment following appendectomy. However, the authors assessed the inter-observer variability in the classification of AA during laparoscopy and demonstrated that agreement was minimal for both the classification of AA ( κ score 0.398) and the decision to prescribe postoperative antibiotic treatment ( κ score 0.378) [ 183 ].…”

Section: Resultsmentioning

confidence: 99%

Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines

et al. 2020

View full text Add to dashboard Cite

Background and aims: Acute appendicitis (AA) is among the most common causes of acute abdominal pain. Diagnosis of AA is still challenging and some controversies on its management are still present among different settings and practice patterns worldwide. In July 2015, the World Society of Emergency Surgery (WSES) organized in Jerusalem the first consensus conference on the diagnosis and treatment of AA in adult patients with the intention of producing evidence-based guidelines. An updated consensus conference took place in Nijemegen in June 2019 and the guidelines have now been updated in order to provide evidence-based statements and recommendations in keeping with varying clinical practice: use of clinical scores and imaging in diagnosing AA, indications and timing for surgery, use of nonoperative management and antibiotics, laparoscopy and surgical techniques, intra-operative scoring, and perioperative antibiotic therapy.

show abstract

Section: Resultsmentioning

confidence: 99%

Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines

et al. 2020

View full text Add to dashboard Cite

show abstract

“…This may have introduced bias in the study, but given the complexity of organising and ethical issues in storing patient data from 16 countries, this was not done. Inter-observer error when grading adhesions which limit surgery is rather subjective, and inter-observer variability has been reported in other laparoscopic assessment and grading, with a recent study in appendicitis showing poor reproducibility [ 31 ]. Our study only requested whether an intra-operative complication occurred or not and further descriptors were not requested.…”

Section: Discussionmentioning

confidence: 99%

Intra-operative gallbladder scoring predicts conversion of laparoscopic to open cholecystectomy: a WSES prospective collaborative study

Sugrue

Catena

Bucholc³

et al. 2019

World J Emerg Surg

View full text Add to dashboard Cite

IntroductionLaparoscopic cholecystectomy, the gold-standard approach for cholecystectomy, has surprisingly variable outcomes and conversion rates. Only recently has operative grading been reported to define disease severity and few have been validated. This multicentre, multinational study assessed an operative scoring system to assess its ability to predict the need for conversion from laparoscopic to open cholecystectomy.MethodsA prospective, web-based, ethically approved study was established by WSES with a 10-point gallbladder operative scoring system; enrolling patients undergoing elective or emergency laparoscopic cholecystectomy between January 2016 and December 2017. Gallbladder surgery was considered easy if the G10 score < 2, moderate (2 ≦ 4), difficult (5 ≦ 7) and extreme (8 ≦ 10). Demographics about the patients, surgeons and operative procedures, use of cholangiography and conversion rates were recorded.ResultsFive hundred four patients, mean age 53.5 (range 18–89), were enrolled by 55 surgeons in 16 countries. Surgery was performed by consultants in 70% and was elective in (56%) with a mean operative time of 78.7 min (range 15-400). The mean G10 score was 3.21, with 22% deemed to have difficult or extreme surgical gallbladders, and 71/504 patients were converted. The G10 score was 2.98 in those completed laparoscopically and 4.65 in the 71/504 (14%) converted. (p < 0.0001; AUC 0.772 (CI 0.719–0.825). The optimal cut-off point of 0.067 (score of 3) was identified in G10 vs conversion to open cholecystectomy. Conversion occurred in 33% of patients with G10 scores of ≥ 5. The four variables statistically predictive of conversion were GB appearance—completely buried GB, impacted stone, bile or pus outside GB and fistula.ConclusionThe G10 operative scores provide simple grading of operative cholecystectomy and are predictive of the need to convert to open cholecystectomy. Broader adaptation and validation may provide a benchmark to understand and improve care and afford more standardisation in global comparisons of care for cholecystectomy.

show abstract

“…Van den boom et al showed short video recordings taken during laparoscopy for suspected appendicitis to 80 surgeons and surgical residents and found that inter-observer agreement was minimal in the classification of appendicitis and in the choice of postoperative antibiotic regime, with only slight improvement when published criteria were used. 14 We did identify a paediatric study using a classification similar to the one used in our study. Feng et al prospectively collected intra-operative findings on 84 children at a single centre and categorised the degree of peritoneal contamination as 'localised' (confined to the right lower quadrant and pelvis) or 'extensive' (extending to the liver upon initial visualisation).…”

Section: Discussionmentioning

confidence: 99%

A simple classification of peritoneal contamination in perforated appendicitis predicts surgery‐related complications

Wee

Park

Lee

et al. 2019

J Paediatrics Child Health

View full text Add to dashboard Cite

Aim Perforated appendicitis has poorer clinical outcomes compared to non‐perforated appendicitis. However, accurate outcome comparisons in research and clinical audits are challenged by its wide spectrum of manifestation. Previous attempts at the classification of severity have been complex and difficult to reproduce. In our study, we used another institution's (Jones et al., TX, USA) previously described simple classification system of peritoneal contamination and examined its usefulness in predicting outcomes. Methods With ethical approval, we retrospectively reviewed the records of all paediatric patients operated at our institution for perforated appendicitis from 2016 to 2017. Patient demographics, intra‐operative and histological findings, post‐operative outcomes and length of stay were collected. Patients were categorised into group 1 (purulence in right lower quadrant only) and group 2 (contamination in two or more quadrants). Post‐operative complications were defined as procedure‐related (e.g. post‐operative ileus, intra‐abdominal abscess, visceral injury) and non‐procedure‐related (e.g. bronchospasm). Statistical analysis using χ2 tests for categorical data and Mann–Whitney U‐tests for non‐parametric continuous variables was performed, with a significance of P < 0.05. Results There were 134 eligible patients. We excluded 19 with incomplete data, leaving 115 for analysis, of which 69 (60%) were in group 2. Those in group 2 had a longer stay (P = 0.005) and more post‐operative complications (P = 0.001), particularly procedure‐related events (P = 0.006). There were no differences in age (P = 0.182), gender (P = 0.876), readmission rate (P = 0.317) and non‐procedure‐related post‐operative complications (0.152). Conclusion This simple classification of perforated appendicitis appears to differentiate clinical outcomes well, particularly for iatrogenic morbidity, making it useful for operative preparation and outcomes research.

show abstract

Interobserver variability in the classification of appendicitis during laparoscopy

Cited by 31 publications

References 35 publications

Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines

Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines

Intra-operative gallbladder scoring predicts conversion of laparoscopic to open cholecystectomy: a WSES prospective collaborative study

A simple classification of peritoneal contamination in perforated appendicitis predicts surgery‐related complications

Contact Info

Product

Resources

About