Controversy in the classification of appendicitis and utilization of postoperative antibiotics
Topic overview
Survey of 562 surgeons reveals poor interrater agreement in classifying appendicitis severity and determining postoperative antibiotic use. Despite lack of evidence, 59% prescribe antibiotics after nongangrenous/nonperforated appendectomy, highlighting need for standardized classification and treatment protocols.
Key takeaways
- Surgeon agreement on appendicitis classification is poor, especially distinguishing perforated vs nonperforated (Krippendorff's alpha = 0.45)
- 59% of surgeons prescribe postoperative antibiotics for nongangrenous/nonperforated appendicitis despite lack of evidence supporting this practice
- Interrater agreement on postoperative antibiotic use is low (Krippendorff's alpha = 0.28), showing wide practice variability
- Only 14% prescribe antibiotics for inflamed appendix, but 44% for suppurative, 75% for gangrenous, and 97% for perforated cases
- Years in practice (16+) was the only significant factor associated with postoperative antibiotic utilization patterns
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