Surgical - pathologic concordance in the diagnosis of the acute apendicitis
DOI:
https://doi.org/10.18004/Keywords:
Appendicitis, Appendectomy, Concordance, Diagnostic errors, ParaguayAbstract
Background: It is necessary to make a correct classification of acute appendicitis due to the different treatment according to the stage of the disease. Several studies have analyzed the surgical and pathologic concordance with varying results. The objective of this study is to determine the correlation between the surgical diagnosis made by the surgeon and the pathological report made by the pathologist. Methods: Observational analytic, inter-observer agreement study, of 266 of patients older than 15 years with a diagnosis of acute appendicitis operated in 2008-2009. Descriptive statistics were used for demographics, and nonparametric statistics (kappa index) to analyze the correlation between the surgical diagnosis and pathology report. Results: 266 patients with an average age of 31 (± 13, 15-86) and male/female ratio of approximately 3:2. The diagnosis of acute appendicitis was performed in 98% and 94% by surgeons and pathologists respectively, with a kappa index of 0.3466 (SE 0.1705, 0.0104-0.6788, 95%). Surgeons diagnosed as such only 24% of the appendix without inflammation confirmed by pathology. Categorizing acute appendicitis as congestive, phlegmonous and gangrenous/perforated a kappa index was obtained of 0.2235 (SE 0.0487, 0.1281-0.3189, 95%). Negative appendectomy was 6%. Conclusions: The surgicalpathologic concordance was poor. Surgeons have an inadequate ability to exactly classify non inflamed appendix. The negative appendectomy rate was low.
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