Predictors of a histopathologic diagnosis of complicated appendicitis

Area of Science:

• Surgical pathology
• Diagnostic imaging
• Clinical decision-making

Background:

• Intraoperative (IO) assessment of complicated appendicitis (CA) is subjective and lacks immediate diagnostic confirmation.
• Histopathologic (HP) diagnosis is the gold standard but is not available during surgery to guide immediate management.
• Accurate preoperative and intraoperative assessment is crucial for effective patient management.

Purpose of the Study:

• To identify predictors that correlate with a histopathologic (HP) diagnosis of complicated appendicitis (CA).
• To improve the accuracy of intraoperative (IO) grading of CA by identifying key predictive factors.
• To provide data for developing more reliable diagnostic criteria for CA.

Main Methods:

• Retrospective review of appendectomy cases from 2011-2013.
• Definition of CA based on perforation or abscess in the pathology report.
• Multivariable regression analysis to evaluate predictors of HP diagnosis of CA.

Main Results:

• Intraoperative (IO) assessment showed association with HP diagnosis of CA (OR: 10.92).
• Significant predictors for HP diagnosis of CA included age (OR: 1.28), pain duration (OR: 1.20), increased heart rate (OR: 1.14), appendix size (OR: 1.09), and appendicolith on CT (OR: 1.74).
• Despite IO assessment, 40% of CA cases were misclassified, highlighting the need for improved diagnostic tools.

Conclusions:

• Preoperative CT findings, including appendix size and appendicolith, along with clinical factors like age, heart rate, and pain duration, are significant predictors of complicated appendicitis (CA).
• Intraoperative assessment, while associated with HP diagnosis, has limitations.
• Integrating these identified predictors into improved intraoperative grading systems may enhance the diagnostic accuracy of CA.