Meaningful standard of reference for appendiceal perforation: pathology, surgery, or both?.
10.4174/astr.2017.93.2.88
- Author:
Hyuk Jung KIM
1
;
Mi Sung KIM
;
Ji Hoon PARK
;
Soyeon AHN
;
Yousun KO
;
Soon Young SONG
;
Ji Young WOO
;
Kyoung Ho LEE
Author Information
1. Department of Radiology, Daejin Medical Center, Bundang Jesaeng General Hospital, Seongnam, Korea.
- Publication Type:Original Article
- Keywords:
Appendicitis;
Perforation
- MeSH:
Adolescent;
Adult;
Appendectomy;
Appendicitis;
Cross-Sectional Studies;
Humans;
Length of Stay;
Logistic Models;
Pathology*;
Retrospective Studies
- From:Annals of Surgical Treatment and Research
2017;93(2):88-97
- CountryRepublic of Korea
- Language:English
-
Abstract:
PURPOSE: This retrospective study was aimed to determine if appendiceal perforation identified pathologically but not surgically is clinically meaningful. METHODS: The study consists of 2 parts. First, we reviewed 74 studies addressing appendiceal perforation published in 2012 and 2013. Second, in a cross-sectional study, we classified 1,438 adolescents and adults (mean age, 29.3 ± 8.4 years; 785 men) with confirmed appendicitis as “nonperforation” (n = 1,083, group 1), “pathologically-identified perforation” (n = 55, group 2), “surgically-identified perforation” (n = 202, group 3), or “pathologically- and surgically-identified perforation” (n = 98, group 4). The 4 groups were compared for the frequency of laparoscopic appendectomy and the length of hospital stay using multivariable logistic regression analyses. RESULTS: The reference standard for appendiceal perforation was frequently missing or inconsistent in the previous studies. Laparoscopic appendectomies were less frequent in groups 3 (52.5%, P = 0.001) and 4 (65%, P = 0.040) than in group 1 (70.7%), while group 2 (73%, P = 0.125) did not significantly differ from group 1. Median hospital stays were 2.9, 3.0, 5.1, and 6.0 days for groups 1–4, respectively. Prolonged hospital stay (≥3.7 days) was more frequent in groups 3 (77.7%, P < 0.001) and 4 (89%, P < 0.001) than in group 1 (23.4%), while group 2 (35%, P = 0.070) did not significantly differ from group 1. CONCLUSION: We recommend using surgical rather than pathologic findings as the reference standard for the presence of appendiceal perforation in future investigations.
