Pre-operative CT predictors associated with 30-day adverse events in patients with appendiceal inflammatory masses who underwent immediate appendectomies

Kim, Myung Sb; Kim, Mi Sung; Kim, Dong Hyun; Park, Hae Won; Park, Heejin; Hong, Hyun Pyo; Kwon, Heon‐Ju

doi:10.1007/s00261-015-0478-9

Cited by 6 publications

(9 citation statements)

References 36 publications

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“…Previous studies have investigated variables affecting outcomes according to individual treatment approach [121314151617]. Our recent study reported that high-grade obstruction identified on preoperative CT is a predictor associated with 30-day adverse events in patients who underwent immediate appendectomy for appendiceal inflammatory mass [12].…”

Section: Discussionmentioning

confidence: 99%

“…Our recent study reported that high-grade obstruction identified on preoperative CT is a predictor associated with 30-day adverse events in patients who underwent immediate appendectomy for appendiceal inflammatory mass [12]. However, that study did not explore the impact of high-grade obstruction on outcomes in patients with appendiceal inflammatory mass treated nonoperatively.…”

Section: Discussionmentioning

confidence: 99%

“…Additional multi-institutional studies with larger sample sizes are required to validate our results. Finally, we evaluated only the presence of high-grade obstruction among bowel obstructions assessed on initial CT examination at presentation, as in our previous study [12], because of ambiguity in differentiating low-grade mechanical obstruction from paralytic ileus [30]. Despite strict criteria for bowel obstruction that excluded milder forms, we found that high-grade obstruction could be relatively well controlled by conservative management and was not associated with adverse outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…They evaluated the presence of appendiceal inflammatory mass (phlegmon or abscess) and high-grade obstruction on initial CT examination at presentation and the presence of complications on follow-up images. Intestinal obstruction was assessed using the same criteria as in our previous study [12], in which low-grade obstructions were excluded to avoid ambiguity in differentiating mechanical obstruction from paralytic ileus. High-grade obstruction was defined as intestinal obstruction directly caused by appendiceal inflammation, with a greater than 50% difference in caliber between the proximal dilated bowel and the distal collapsed bowel [22], in addition to the presence of a transition zone.…”

Section: Methodsmentioning

confidence: 99%

“…Several studies have shown that CT helps predict the severity of appendicitis [11] or treatment outcomes in patients with appendiceal inflammatory masses [1213]. Our previous study [12] found that high-grade obstruction identified on preoperative CT is associated with immediate postoperative complications in patients who underwent immediate appendectomy for appendiceal inflammatory mass. However, we did not explore nonoperative treatment as an alternative treatment approach.…”

Section: Introductionmentioning

confidence: 99%

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Impact of high-grade obstruction on outcomes in patients with appendiceal inflammatory masses managed by nonoperative treatment

Kim

Park

et al. 2017

Ann Surg Treat Res

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PurposeTo retrospectively assess the impact of high-grade obstructions identified on initial CT on outcomes of patients with appendiceal inflammatory masses managed by nonoperative treatment.MethodsInstitutional Review Boards approved this retrospective study and informed consent was waived. Included were 52 consecutive patients diagnosed with appendiceal inflammatory masses by CT scan and managed by nonoperative treatment. The main outcome measure was treatment failure and secondary outcomes were complications and initial and total hospital stay. Patient demographics, inflammatory markers, and CT findings for presence of an appendiceal inflammatory mass and high-grade obstruction were assessed. Patients with and without high-grade obstruction were compared for patient characteristics and outcomes using Fisher exact test and Student t-test.ResultsAmong 52 patients, 14 (27%) had high-grade obstruction on CT examination at presentation. No significant differences were observed in patient characteristics (P > 0.05), treatment failure (P = 0.33), complications (P = 0.29), or initial (P = 0.73) or total (P = 0.72) hospitalization between patients with and without high-grade obstruction.ConclusionFor patients who were managed by nonoperative treatment for appendiceal inflammatory masses, the presence of high-grade obstruction identified on initial CT scan did not significantly affect outcomes of treatment failure, complications, and initial and total hospitalization.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Impact of high-grade obstruction on outcomes in patients with appendiceal inflammatory masses managed by nonoperative treatment

Kim

Park

et al. 2017

Ann Surg Treat Res

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Right hydronephrosis as a sign of complicated appendicitis

Lee

Woo

Byun

2020

European Journal of Radiology

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The Reliability of a Standardized Reporting System for the Diagnosis of Appendicitis

Simianu

Shamitoff

Hippe

et al. 2017

Current Problems in Diagnostic Radiology

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Purpose Computed tomography (CT) is a fast and ubiquitous tool to evaluate intra-abdominal organs and diagnose appendicitis. However, traditional CT reporting does not necessarily capture the degree of uncertainty and indeterminate findings are still common. The purpose of this study was to evaluate the reproducibility of a standardized CT reporting system for appendicitis across a large population and the system’s impact on radiologists’ certainty in diagnosing appendicitis. Methods Using a previously described standardized reporting system, eight radiologists retrospectively evaluated CT scans in a cohort of 561 patients imaged for possible appendicitis (2010–2014). Based on the original reports, 159 of these scans were selected to be over-read by a second reviewer. Reproducibility of reporting and certainty in the diagnosis of appendicitis was compared between the radiologists, and correlation made with clinical diagnoses. Results Appendicitis occurred in 20% of patients (mean age 38, 67% male) in the overall cohort (n=113 of 561). Using the standardized report, radiologists were highly accurate at identifying appendicitis (AUC=0.968, 95%CI: 0.95, 0.99), which occurred in 48% of selected exams (113 of 237). Inter-reader agreement was >80% for most objective findings, and certainty in diagnosing appendicitis was high and reproducible (AUC=0.955 and AUC=0.936 for primary readers and over-readers, respectively). In the subgroup of patients with previously “indeterminate” reports, 57% (24 of 42) were assigned the correct diagnosis using the standardized report. Conclusions Using a standardized reporting system resulted in high reproducibility of objective CT findings for appendicitis and achieved high diagnostic accuracy in an at-risk population. Predictive tools based on this reporting system may further improve communication about certainty in diagnosis and guide patient management, especially when CT findings are indeterminate.

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Pre-operative CT predictors associated with 30-day adverse events in patients with appendiceal inflammatory masses who underwent immediate appendectomies

Abstract: High-grade obstruction was an independent pre-operative CT predictor associated with 30-day adverse events in patients who underwent immediate appendectomies for appendiceal inflammatory masses.

Cited by 6 publications

References 36 publications

Impact of high-grade obstruction on outcomes in patients with appendiceal inflammatory masses managed by nonoperative treatment

Impact of high-grade obstruction on outcomes in patients with appendiceal inflammatory masses managed by nonoperative treatment

Right hydronephrosis as a sign of complicated appendicitis

The Reliability of a Standardized Reporting System for the Diagnosis of Appendicitis

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