@article{ea1d56b6fa94436eba4886f8227ed855,
title = "Discrepancies between Intraoperative and Histological Evaluation of the Appendix in Acute Appendicitis",
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",
author = "Bolmers, \{Matthijs D. M.\} and \{de Jonge\}, Joske and \{van Rossem\}, \{Charles C.\} and \{van Geloven\}, \{Anna A. W.\} and Bemelman, \{Willem A.\} and \{On behalf of the Snapshot Appendicitis Collaborative Study group\} and \{van Acker\}, \{G. J.\} and B. Akkermans and Akkersdijk, \{G. J.\} and Algie, \{G. D.\} and Allema, \{J. H.\} and Andeweg, \{C. S.\} and N. Appeldoorn and \{van Baal\}, \{J. G.\} and \{den Bakker\}, \{C. M.\} and Bartels, \{S. A.\} and \{van den Berg\}, C. and B. Boekestijn and \{den Boer\}, \{F. C.\} and D. Boerma and \{van den Boom\}, \{A. L.\} and Boute, \{M. C.\} and Bouwense, \{S. A.\} and J. Bransen and \{van Brussel\}, \{F. A.\} and Busch, \{O. R.\} and \{de Castro\}, \{S. M.\} and Cense, \{H. A.\} and C. Croese and \{van dalen\}, T. and I. Dawson and \{van Dessel\}, E. and R. Dettmers and N. Dhar and Dohmen, \{F. Y.\} and \{van Dongen\}, \{K. W.\} and \{van Duijvendijk\}, P. and Dulfer, \{R. R.\} and Dwars, \{B. J.\} and Eerenberg, \{J. P.\} and \{van der Elst\}, M. and \{van den Ende\}, E. and Fassaert, \{L. M.\} and Fikkers, \{J. T.\} and Foppen, \{J. W.\} and Furnee, \{E. J.\} and Garssen, \{F. P.\} and Gerhards, \{M. F.\} and \{van Goor\}, H. and \{de Graaf\}, \{J. S.\} and Lases, \{S. S.\} and \{van der Ham\}, \{A. C.\} and \{van Heurn\}, E. and Ottenhof, \{A. G.\} and \{van der Peet\}, \{D. L.\} and H. Rijna and J. Straatman and \{van Susante\}, \{H. J.\} and Volders, \{J. H.\} and Wever, \{Jan J.\} and Wijfels, \{N. A.\} and Wijnhoven, \{Bas P.L.\} and Winkel, \{T. A.\} and \{van der Zee\}, \{David C.\} and Zeillemaker, \{A. M.\} and C. Zietse",
note = "Funding Information: Snapshot Appendicitis Collaborative Study group: Van AckerGJ, Akkermans B, AkkersdijkGJ, Algie GD, Allema JH, Andeweg CS, Appeldoorn N, van Baal JG, den Bakker CM, Bartels SA, van den Berg C, Boekestijn, B, den Boer FC, Boerma D, van den Boom AL, Boute MC, Bouwense SA, Bransen J, van Brussel FA, Busch OR, de Castro SM, Cense HA, Croese, C, van dalen T, Dawson I, van Dessel E, Dettmers R, DharN, Dohmen FY, van Dongen KW, van Duijvendijk P, DulferRR, Dwars BJ, Eerenberg JP, van der Elst M, van den Ende E, Fassaert LM, Fikkers JT, Foppen, JW, Furnee, EJ, Garssen FP, Gerhards MF, van Goor H, de Graaf JS, Graat LJ, Grootr J, van der Ham AC, Hamming JF, Hamminga JT, van der Harst E, Heemskerk J, Heijne A, Heikens JT, Heineman E, Hertogs R, van Heurn E, van den Hil LC, Hooftwijk AG, Hulsker CC, Hunen DR, Ibelings MS, Klaase JM, Klicks R, Knaapen L, Kortekaas RT, Kruyt F, Kwant S, Lases SS, LettingaT, Loupatty A, Matthijsen RA, Minnee RC, Mirck B, Mitalas L, Moes D, Moorman AM, Nieuwenhuijs VB, Nieuwenhuizen GA, Nijk PD, Omloo JM, Ottenhof AG, Palamba HW, van der Peet DL, Pereboom IT, Plaisier PW, van der Ploeg AP, Raber MH, Reijen MM, Rijna H, Rosman C, Roumen RM, Scmitz RF, Schouten van der Velden AP, Scheurs WH, Sigterman TA, Smeets HJ, Sonnevled DJ, Sosef MN, Spoor SF, Stassen LP, van Steensel L, Stortelder E, Straatman J, van Susante HJ, Suykerbuyk de Hoog DE, Terwisscha van Scheltinga C, Toorenvliet BR, Verbeek PC, Verseveld M, Volders JH, Vriens MR, Vriens PW, Vrouenraets BC, van de wall BJ, Wegdam JA, WesterduinE, Wever JJ, Wijfels NA, Wijnhoven BP, Winkel TA, van der Zee DC Zeillemaker AM, Zietse C. Publisher Copyright: {\textcopyright} 2019, The Society for Surgery of the Alimentary Tract. Copyright: Copyright 2020 Elsevier B.V., All rights reserved.",
year = "2020",
month = sep,
day = "1",
doi = "10.1007/s11605-019-04345-3",
language = "English",
volume = "24",
pages = "2088--2095",
journal = "Journal of gastrointestinal surgery",
issn = "1091-255X",
publisher = "Springer New York",
number = "9",
}