Acute appendicitis. Prospective trial concerning diagnostic accuracy and complications

Area of Science:

• Surgical pathology
• Clinical diagnostics
• Epidemiology

Background:

• Acute appendicitis is a common surgical emergency.
• Accurate diagnosis is crucial to prevent complications like perforation.
• Diagnostic challenges exist, particularly in specific patient demographics.

Purpose of the Study:

• To evaluate the diagnostic accuracy of appendicitis surgery.
• To identify patient groups with lower diagnostic accuracy.
• To assess the incidence of perforation and its impact on postoperative complications.

Main Methods:

• Prospective trial involving 202 patients undergoing surgery for suspected acute appendicitis.
• Histologic examination of all removed appendices for definitive diagnosis.
• Analysis of diagnostic accuracy, perforation rates, and postoperative complications across different patient groups.

Main Results:

• Overall diagnostic accuracy was 70%.
• Lower accuracy (approx. 60%) observed in women under 50 and patients ≤20 years old, attributed to gynecologic issues and atypical pain.
• Perforation occurred in 16% of appendicitis cases, with higher frequency in patients >50 years old.
• Postoperative complications were 11% overall, significantly higher (39%) in perforated appendicitis cases compared to non-perforated (4-8%).

Conclusions:

• Appendicitis diagnosis can be challenging, especially in younger women and adolescents.
• Perforation significantly increases the risk of postoperative complications.
• Risk stratification and diagnostic refinement are needed for vulnerable patient groups.