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Ann Surg Treat Res. 2017 Aug;93(2):88-97. doi: 10.4174/astr.2017.93.2.88. Epub 2017 Jul 28.

Meaningful standard of reference for appendiceal perforation: pathology, surgery, or both?

Author information

1
Department of Radiology, Daejin Medical Center, Bundang Jesaeng General Hospital, Seongnam, Korea.
2
Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.
3
Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
4
Division of Statistics, Medical Research Collaborating Center, Seoul National University Bundang Hospital, Seongnam, Korea.
5
Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea.
6
Program in Biomedical Radiation Sciences, Department of Transdisciplinary Studies, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Korea.
7
Department of Radiology, Hanyang University Hospital, Seoul, Korea.
8
Department of Radiology, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea.

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.

KEYWORDS:

Appendicitis; Perforation

Conflict of interest statement

CONFLICTS OF INTEREST: No potential conflict of interest relevant to this article was reported.

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