Interobserver variability in the classification of appendicitis during laparoscopy. BJS 2018; 105: 1014-1019.
Published: 16th April 2018
Authors: A. L. van den Boom, E. M. L. de Wijkerslooth, K. A. L. Mauff, I. Dawson, C. C. van Rossem, B. R. Toorenvliet et al.
The intraoperative classification of appendicitis dictates the patient's postoperative management. Prolonged antibiotic prophylaxis is recommended for complex appendicitis (gangrenous, perforated, abscess), whereas preoperative prophylaxis suffices for simple appendicitis. Distinguishing these two conditions can be challenging. The aim of this study was to assess interobserver variability in the classification of appendicitis during laparoscopy.
Short video recordings taken during laparoscopy for suspected appendicitis were shown to surgeons and surgical residents. They were asked to: classify the appendix as indicative of no, simple or complex appendicitis; categorize the appendix as normal, phlegmonous, gangrenous, perforated and/or abscess; and decide whether they would prescribe postoperative antibiotics. Inter‐rater reliability was evaluated using Fleiss' κ score and the S* statistic.
Some 80 assessors participated in the study. Video recordings of 20 patients were used. Interobserver agreement was minimal for both the classification of appendicitis (κ score 0·398, 95 per cent c.i. 0·385 to 0·410) and the decision to prescribe postoperative antibiotic treatment (κ score 0·378, 0·362 to 0·393). Agreement was slightly higher when published criteria were applied (κ score 0·552, 0·537 to 0·568).
There is considerable variability in the intraoperative classification of appendicitis and the decision to prescribe postoperative antibiotic treatment.Full text
You may also be interested in
Authors: T. J. Patterson, J. Beck, P. J. Currie, R. A. J. Spence, G. Spence
Authors: L. de Munter, S. Polinder, C. L. P. van de Ree, N. Kruithof, K. W. W. Lansink, E. W. Steyerberg et al.
Surgical removal of the index node marked using magnetic seed localization to assess response to neoadjuvant immunotherapy in patients with stage III melanoma.
Authors: B. Schermers, V. Franke, E. A. Rozeman, B. A. van de Wiel, A. Bruining, M. W. Wouters et al.
Nationwide observational study of mortality from complicated intra‐abdominal infections and the role of bacterial cultures.
Authors: A. Tsuchiya, H. Yasunaga, Y. Tsutsumi, T. Kawahara, H. Matsui, K. Fushimi et al.
Impact of enhanced recovery on oncological outcomes following minimally invasive surgery for rectal cancer.
Authors: B. J. Quiram, J. Crippa, F. Grass, J. K. Lovely, K. T. Behm, D. T. Colibaseanu et al.
Prospective cohort study of ultrasound surveillance of regional lymph nodes in patients with intermediate‐risk cutaneous melanoma.
Authors: A. J. Hayes, E. Moskovic, K. O'Meara, H. G. Smith, R. J. E. Pope, J. Larkin et al.
Multicentre study of non‐surgical management of diverticulitis with abscess formation. BJS 2019; 106: 458-466.
Authors: D. P. V. Lambrichts, H. E. Bolkenstein, D. C. H. E. van der Does, D. Dieleman, R. M. P. H. Crolla, J. W. T. Dekker et al.
Authors: S. Biondo
Randomized clinical trial
Randomized clinical trial of selective decontamination of the digestive tract in elective colorectal cancer surgery (SELECT trial). BJS 2019; 106: 355-363.
Authors: G. S. A. Abis, H. B. A. C. Stockmann, H. J. Bonjer, N. van Veenendaal, M. L. M. van Doorn‐Schepens, A. E. Budding et al.
Authors: R. Miller, J. C. R. Wormald, R. G. Wade, D. P. Collins
Time to calcitonin normalization after surgery for node‐negative and node‐positive medullary thyroid cancer. BJS 2019; 106: 412-418.
Authors: A. Machens, K. Lorenz, H. Dralle
Notes: Sensitive as prognostic tool