Appendicitis in children: correlation between the surgical and histological diagnosis
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In brief
In brief
This retrospective study of 1,444 pediatric appendicitis cases demonstrates strong correlation between surgeons' intraoperative assessments and histopathological findings. Underestimation of disease severity by surgeons correlates with longer hospital stays and higher complication rates, highlighting the importance of accurate intraoperative staging.
- Strong correlation (kappa 0.637) exists between surgeon's intraoperative assessment and histopathology in pediatric appendicitis severity.
- Underestimating appendicitis severity intraoperatively increases complication risk and prolongs hospital stay (4 vs 3 days median).
- Complicated appendicitis cases are reliably identifiable during surgery, with similar accuracy for laparoscopic and open approaches.
- Accurate intraoperative staging of appendicitis severity guides appropriate postoperative management and predicts clinical outcomes.
- Surgeon's visual assessment during appendectomy has substantial clinical validity for determining disease severity in children.
Written by the GCMD Library team from the article.
Abstract
Purpose
Study was designed in order to evaluate the discrepancies between surgical and histological diagnosis in pediatric acute appendicitis (AA) and to compare the outcomes of laparoscopic (LA) and open appendectomies (OA).
Methods
In a retrospective observational cohort, AA patients were included under 18 years of age, operated between 2011 and 2020. Surgical diagnosis was defined by the operating surgeon. The histological findings were classified as uncomplicated and complicated AA. The LOS and complications were also statistically analyzed.
Results
Altogether, 1444 patients were included. Significant strong correlation and a moderate to substantial agreement were found between the surgeon’s and the histopathological findings in all appendectomy cases (weighted kappa value in OA: 0.633, LA: 0.639, total sample: 0.637). If the surgeon’s diagnosis was less severe than the pathologist’s, the LOS was 4 (3;7) days, whereas if the surgical diagnosis was correct, the LOS was 3 (3;5) days (p < 0.0001).
Conclusions
In contrary to the literature, our study revealed a strong correlation and moderate agreement between the intraoperative and histopathological findings regarding the severity of AA. Complicated cases are distinctly recognizable during the surgery. In case the surgeon underestimates the severity of AA, the chance of complications is higher.
Level of evidence: II