Low intra-operative diagnostic accuracy does not affect postoperative treatment of acute appendicitis

Acta Chir Belg. 2020 Dec;120(6):390-395. doi: 10.1080/00015458.2019.1642578. Epub 2019 Jul 16.

Abstract

Background: The intra-operative classification of appendicitis defines postoperative treatment. The correct designation can influence patient recovery, complications and hospital costs. Recent research has shown that intra-operative classification criteria varies among surgeons, and is not always the same as the pathologist's report. Classification accuracy can lower costs by preventing unnecessary treatment or sub-optimal interventions.

Methods: During a period of 4 months, N = 133 appendix specimens were received and evaluated by the pathology department of a single teaching hospital. Five surgeons extracted the specimens and one experienced pathologist drew the histopathology reports. A comparison between the surgeons' classifications and the pathologist's was made. Classification accuracy was determined and statistical analyses was performed using chi-square, and p values were obtained. A p < 0.05 was considered significant.

Results: A total of N = 133 specimens were obtained, 127 belonged to patients following emergency surgery due to acute abdominal pain; the other six were from elective hemi-colectomies for right colonic adenocarcinomas, and were not included. Of the 127 specimens analyzed, 14 (11%) were negative, 21 (16.5%) were edematous, 81 (63.7%) were phlegmonous and 11 (8.6%) were gangrenous. A total of 18 (14%) perforated appendices were also reported. Surgical accuracy was 60.6% (N = 67) with a statistically significant p < 0.001. Only five patients with incorrect intraoperative classifications received unnecessary or lacked treatment.

Conclusions: An overall accuracy of 60.6% is seen when the surgical classification is compared to the pathological classification. Although the surgeons' accuracy is low when comparing intra-operative versus histopathological classification, this variation in designation does not affect postoperative treatment significantly.

Keywords: Appendicitis; appendectomy; inflammation accuracy.

MeSH terms

  • Adult
  • Appendectomy*
  • Appendicitis / diagnosis*
  • Appendicitis / etiology*
  • Appendicitis / surgery
  • Female
  • Humans
  • Male
  • Postoperative Care*
  • Predictive Value of Tests
  • Reproducibility of Results
  • Retrospective Studies