Discrepancies between Intraoperative and Histological Evaluation of the Appendix in Acute Appendicitis

Matthijs D M Bolmers¹, Joske de Jonge², Charles C van Rossem³, Anna A W van Geloven¹, Willem A Bemelman⁴; Snapshot Appendicitis Collaborative Study group

Collaborators, Affiliations

Collaborators

Snapshot Appendicitis Collaborative Study group:
G J Van Acker, B Akkermans, G J Akkersdijk, G D Algie, J H Allema, C S Andeweg, N Appeldoorn, J G van Baal, C M den Bakker, S A Bartels, C van den Berg, B Boekestijn, F C den Boer, D Boerma, A L van den Boom, M C Boute, S A Bouwense, J Bransen, F A van Brussel, O R Busch, S M de Castro, H A Cense, C Croese, T van Dalen, I Dawson, E van Dessel, R Dettmers, N Dhar, F Y Dohmen, K W van Dongen, P van Duijvendijk, R R Dulfer, B J Dwars, J P Eerenberg, M van der Elst, E van den Ende, L M Fassaert, J T Fikkers, J W Foppen, E J Furnee, F P Garssen, M F Gerhards, H van Goor, J S de Graaf, L J Graat, J Grootr, A C van der Ham, J F Hamming, J T Hamminga, E van der Harst, J Heemskerk, A Heijne, J T Heikens, E Heineman, R Hertogs, E van Heurn, L C van den Hil, A G Hooftwijk, C C Hulsker, D R Hunen, M S Ibelings, J M Klaase, R Klicks, L Knaapen, R T Kortekaas, F Kruyt, S Kwant, S S Lases, T Lettinga, A Loupatty, R A Matthijsen, R C Minnee, B Mirck, L Mitalas, D Moes, A M Moorman, V B Nieuwenhuijs, G A Nieuwenhuizen, P D Nijk, J M Omloo, A G Ottenhof, H W Palamba, D L van der Peet, I T Pereboom, P W Plaisier, A P van der Ploeg, M H Raber, M M Reijen, H Rijna, C Rosman, R M Roumen, R F Scmitz, A P Schouten van der Velden, W H Scheurs, T A Sigterman, H J Smeets, D J Sonnevled, M N Sosef, S F Spoor, L P Stassen, L van Steensel, E Stortelder, J Straatman, H J van Susante, D E Suykerbuyk de Hoog, C Terwisscha van Scheltinga, B R Toorenvliet, P C Verbeek, M Verseveld, J H Volders, M R Vriens, P W Vriens, B C Vrouenraets, B J van de Wall, J A Wegdam, E Westerduin, J J Wever, N A Wijfels, B P Wijnhoven, T A Winkel, D C van der Zee, A M Zeillemaker, C Zietse

Affiliations

¹ Department of Surgery, Tergooi Hospital Hilversum, 10016, 1213 XZ, Hilversum, The Netherlands.
² Department of Surgery, Tergooi Hospital Hilversum, 10016, 1213 XZ, Hilversum, The Netherlands. jdejonge@tergooi.nl.
³ Department of Surgery, Maasstad Hospital Rotterdam, 9100, 3007 AC, Rotterdam, The Netherlands.
⁴ Department of Surgery, Amsterdam University Medical Center, University of Amsterdam, 22660, 1105 AZ, Amsterdam, The Netherlands.

PMID: 31410818
DOI: 10.1007/s11605-019-04345-3

Multicenter Study

Discrepancies between Intraoperative and Histological Evaluation of the Appendix in Acute Appendicitis

Matthijs D M Bolmers et al. J Gastrointest Surg. 2020 Sep.

. 2020 Sep;24(9):2088-2095.

doi: 10.1007/s11605-019-04345-3. Epub 2019 Aug 13.

Authors

Matthijs D M Bolmers¹, Joske de Jonge², Charles C van Rossem³, Anna A W van Geloven¹, Willem A Bemelman⁴; Snapshot Appendicitis Collaborative Study group

Collaborators

Snapshot Appendicitis Collaborative Study group:
G J Van Acker, B Akkermans, G J Akkersdijk, G D Algie, J H Allema, C S Andeweg, N Appeldoorn, J G van Baal, C M den Bakker, S A Bartels, C van den Berg, B Boekestijn, F C den Boer, D Boerma, A L van den Boom, M C Boute, S A Bouwense, J Bransen, F A van Brussel, O R Busch, S M de Castro, H A Cense, C Croese, T van Dalen, I Dawson, E van Dessel, R Dettmers, N Dhar, F Y Dohmen, K W van Dongen, P van Duijvendijk, R R Dulfer, B J Dwars, J P Eerenberg, M van der Elst, E van den Ende, L M Fassaert, J T Fikkers, J W Foppen, E J Furnee, F P Garssen, M F Gerhards, H van Goor, J S de Graaf, L J Graat, J Grootr, A C van der Ham, J F Hamming, J T Hamminga, E van der Harst, J Heemskerk, A Heijne, J T Heikens, E Heineman, R Hertogs, E van Heurn, L C van den Hil, A G Hooftwijk, C C Hulsker, D R Hunen, M S Ibelings, J M Klaase, R Klicks, L Knaapen, R T Kortekaas, F Kruyt, S Kwant, S S Lases, T Lettinga, A Loupatty, R A Matthijsen, R C Minnee, B Mirck, L Mitalas, D Moes, A M Moorman, V B Nieuwenhuijs, G A Nieuwenhuizen, P D Nijk, J M Omloo, A G Ottenhof, H W Palamba, D L van der Peet, I T Pereboom, P W Plaisier, A P van der Ploeg, M H Raber, M M Reijen, H Rijna, C Rosman, R M Roumen, R F Scmitz, A P Schouten van der Velden, W H Scheurs, T A Sigterman, H J Smeets, D J Sonnevled, M N Sosef, S F Spoor, L P Stassen, L van Steensel, E Stortelder, J Straatman, H J van Susante, D E Suykerbuyk de Hoog, C Terwisscha van Scheltinga, B R Toorenvliet, P C Verbeek, M Verseveld, J H Volders, M R Vriens, P W Vriens, B C Vrouenraets, B J van de Wall, J A Wegdam, E Westerduin, J J Wever, N A Wijfels, B P Wijnhoven, T A Winkel, D C van der Zee, A M Zeillemaker, C Zietse

Affiliations

¹ Department of Surgery, Tergooi Hospital Hilversum, 10016, 1213 XZ, Hilversum, The Netherlands.
² Department of Surgery, Tergooi Hospital Hilversum, 10016, 1213 XZ, Hilversum, The Netherlands. jdejonge@tergooi.nl.
³ Department of Surgery, Maasstad Hospital Rotterdam, 9100, 3007 AC, Rotterdam, The Netherlands.
⁴ Department of Surgery, Amsterdam University Medical Center, University of Amsterdam, 22660, 1105 AZ, Amsterdam, The Netherlands.

PMID: 31410818
DOI: 10.1007/s11605-019-04345-3

Abstract

Purpose: To identify discrepancies between intraoperative and histological evaluations of the appendix in acute appendicitis and to evaluate the effect on surgical outcome.

Methods: Data was used from our previous multicentre, prospective, cohort study of patients with suspected acute appendicitis. Appendices were scored during intraoperative and histological evaluation as uncomplicated or complicated appendicitis. Primary outcome was percentage of concordance between intraoperative and histological evaluation. Secondary outcomes were (infectious) postoperative complications, length of hospital stay, hospital re-admission and re-intervention rate, all within 30 days of surgery.

Results: A total of 1850 patients were included. In 65.7% (1215/1850) of the appendices, the intraoperative evaluation was uncomplicated and in 34.3% (635/1850), complicated appendicitis. Patients with uncomplicated appendicitis had a postoperative course with significantly less postoperative complications (7.2% vs 24.3%), a shorter length of hospital stay (2 vs 5 days) and a lower re-admission (4.2% vs 9.6%) and re-intervention rate (1.1% vs 4.3%) than intraoperative complicated appendicitis (p < 0.001). In 93.5% (1136/1215) of the intraoperative uncomplicated patients and in 46.6% (296/635) of the intraoperative complicated patients, there was an agreement with pathology (Kappa 0.45). In 23.9% (81/339) of patients with intraoperative complicated and histological uncomplicated appendicitis, a postoperative complication was observed, which was similar to the postoperative complication rate of complicated appendicitis both on intraoperative and histological evaluation (24.7% (73/296)).

Conclusions: There is a moderate agreement between a surgeon and pathologist in diagnosing patients with complicated appendicitis. However, the intraoperative diagnosis of complicated appendicitis was significantly associated with postoperative complications. Routine histological evaluation should be preserved for excluding malignancies in suspect appendices.

Keywords: Acute appendicitis; Histological evaluation; Interobserver agreement; Intraoperative evaluation; Surgical evaluation.

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References

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1. CBS appendectomies.
1. Van Rossem CC, Bolmers M, Schreinemacher MHF, Van Geloven AAW, Bemelman WA. Prospective nationwide outcome audit of surgery for suspected acute appendicitis. 2015. https://doi.org/10.1002/bjs.9964 .
1. Buckius MT, McGrath B, Monk J, Grim R, Bell T, Ahuja V. Changing epidemiology of acute appendicitis in the United States: Study period 1993-2008. J Surg Res. 2012. https://doi.org/10.1016/j.jss.2011.07.017 .
1. Cueto J, D’Allemagne B, Vázquez-Frias JA, et al. Morbidity of laparoscopic surgery for complicated appendicitis: An international study. Surg Endosc Other Interv Tech. 2006. https://doi.org/10.1007/s00464-005-0402-4 .

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Discrepancies between Intraoperative and Histological Evaluation of the Appendix in Acute Appendicitis

Collaborators

Affiliations

Discrepancies between Intraoperative and Histological Evaluation of the Appendix in Acute Appendicitis

Authors

Collaborators

Affiliations

Abstract

References

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources

Medical