Agreement between histopathological and intraoperative classifications for pediatric appendicitis and its relationship with the post-operative clinical outcome

Camila de Paula Silva; Erika Veruska Paiva Ortolan; Sergio Marrone Ribeiro; Bruna Aliotto Nalin Tedesco; Simone Antunes Terra; Maria Aparecida Marchesan Rodrigues; Pedro Luiz Toledo de Arruda Lourenção

doi:10.3389/fped.2022.908226

Agreement between histopathological and intraoperative classifications for pediatric appendicitis and its relationship with the post-operative clinical outcome

Front Pediatr. 2022 Aug 3:10:908226. doi: 10.3389/fped.2022.908226. eCollection 2022.

Authors

Camila de Paula Silva¹, Erika Veruska Paiva Ortolan², Sergio Marrone Ribeiro¹, Bruna Aliotto Nalin Tedesco², Simone Antunes Terra³, Maria Aparecida Marchesan Rodrigues³, Pedro Luiz Toledo de Arruda Lourenção²

Affiliations

¹ Department of Infectious Diseases, Dermatology, Diagnostic Imaging, and Radiotherapy, Botucatu Medical School, São Paulo State University (Unesp), Botucatu, Brazil.
² Division of Pediatric Surgery, Department of Surgery and Orthopedics, Botucatu Medical School, São Paulo State University (Unesp), Botucatu, Brazil.
³ Department of Pathology, Botucatu Medical School, São Paulo State University (Unesp), Botucatu, Brazil.

Abstract

Introduction: Some studies have shown poor agreement between intraoperative and histopathological classifications for appendicitis, despite their routine use in clinical practice.

Objective: To investigate the agreement between histopathological and intraoperative classifications for pediatric appendicitis and evaluate the predictive potential of these classifications for the post-operative outcome.

Methods: A retrospective, longitudinal, observational single-center study, carried out with 485 patients up to15 years of age, with a confirmed diagnosis of acute appendicitis by histopathological evaluation. The histopathological results classified the appendices as uncomplicated appendicitis when there was confirmation of the diagnosis of appendicitis without necrosis or perforation and complicated appendicitis when there was extensive necrotic tissue in the outer layer of the appendix or signs of perforation. The intraoperative findings were classified as uncomplicated appendicitis when the appendix presented with hyperemia and edema or fibrinous exudate and complicated appendicitis when the appendix showed necrosis, abscess, or perforation. The kappa index determined the agreement and the prediction relationships using a generalized linear model.

Results: 43.9% of cases were classified as complicated appendicitis by histopathological evaluation and 49.7% by intraoperative classification. The agreement analysis between the histopathological and intraoperative classification showed a moderate agreement, with a Kappa index of 0.419 (0.337-0.501). There was an association (P < 0.05) between the intraoperative classification and the post-operative clinical outcomes (time to start feeding, fever, intraabdominal collection, length of stay, the need for antibiotic therapy changing, and need for ICU). There was no association between histopathological classification and post-operative outcomes.

Conclusion: The agreement between the two classifications was moderate, and the intraoperative classification was able to predict the post-operative clinical outcomes.

Keywords: appendicitis; appendicitis clinical outcome; histological appendicitis classification; intraoperative appendicitis classification; pediatric.