title: Correlation between intraoperative surgical diagnosis of complicated acute appendicitis and the pathology report: clinical implications.
abstract: BACKGROUND
  The post-operative management of appendectomy for acute appendicitis is based primarily on the operative findings. The surgeon describes the severity of the disease, and antibiotic therapy is administered accordingly. The histologic findings are not always considered in the decision about the management and may not be correlated with the clinical outcome. The aim of this study was to investigate the agreement between the surgeon's intra-operative visual description of the appendix and the pathologist's report in a consecutive series of patients with acute appendicitis. Complications were analyzed in relation to the classification.
  
  
  METHODS
  A comparative observational study was performed in 69 patients who underwent surgery for acute appendicitis at the same hospital during a one-year period (the entire year of 2011). The surgeon's classification of the severity of appendicitis was compared with the pathologist's report using the kappa coefficient. Patient demographics, surgical techniques, and post-operative complications also were analyzed.
  
  
  RESULTS
  Complicated appendicitis (gangrenous or perforated) was considered to be present in 36.2% of patients in the surgeon's classification and 43% of the patients in the histopathologic reports (p=0.033). The kappa coefficient showed only a weak correlation between the surgeons' and pathologists' descriptions (κ=0.25). Significant differences in post-operative complications were found only in the surgeon's classification.
  
  
  CONCLUSIONS
  We found a weak correlation between the surgeon's macroscopic diagnosis and the pathologic findings. However, the differences did not have meaningful clinical implications. Further studies are required to evaluate the clinical meaning of these results.
authors.affiliation: Department of General and Digestive Surgery, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona , Sant Boi de Llobregat, Barcelona, Spain .
authors.forename: Jessica
authors.initials: J
authors.lastname: Correa
authors.forename: Jaime
authors.initials: J
authors.lastname: Jimeno
authors.forename: Helena
authors.initials: H
authors.lastname: Vallverdu
authors.forename: Cinzia
authors.initials: C
authors.lastname: Bizzoca
authors.forename: Francesc
authors.initials: F
authors.lastname: Collado-Roura
authors.forename: Laia
authors.initials: L
authors.lastname: Estalella
authors.forename: Judith
authors.initials: J
authors.lastname: Hermoso
authors.forename: Natalia
authors.initials: N
authors.lastname: Silva
authors.forename: Cristina
authors.initials: C
authors.lastname: Sanchez-Pradell
authors.forename: David
authors.initials: D
authors.lastname: Parés
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001064:Appendicitis / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery*; D015510:Clinical Medicine / Q000379:methods*; D005260:Female; D006651:Histocytochemistry / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care / Q000379:methods*; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents