title: Correlating surgical and pathological diagnoses in pediatric appendicitis.
abstract: BACKGROUND
  The stratification of appendicitis into simple and complex variants has far-reaching implications. While the operative diagnosis made by the surgeon dictates clinical management, the pathologic diagnosis often differs and is frequently used for coding and reimbursement. The purpose of this study was to examine discrepancies between the operative and pathologic diagnoses with subsequent correlation to clinical outcomes.
  
  
  METHODS
  Patients with acute appendicitis from July 2011 to July 2012 were identified. Diagnoses included simple (normal, acute, and suppurative) and complex (gangrenous and perforated). We evaluated the inter-rater reliability between pathologic and operative diagnoses in the five appendicitis categories. Clinical outcomes of deep and superficial surgical site infections were evaluated according to the pathologic and surgical diagnosis.
  
  
  RESULTS
  During the study period, we identified 1166 patients with acute appendicitis. The surgeon and pathologist agreed on the specific diagnosis (acute, suppurative, gangrenous, perforated, normal) in 48% of patients (kappa 0.289, 95% CI 0.259-0.324, p=0.001). Agreement on disease severity (simple vs. complex) improved to 82%. The operative diagnosis more accurately predicted infectious complications than the pathologic diagnoses.
  
  
  CONCLUSIONS
  Significant discordance exists between surgical and pathologic diagnoses. While the relevance of this discordance to clinical outcomes is still not clear, a potential for incorrect hospital coding and subsequent reimbursement exists. Future quality improvement projects should focus on standardizing the surgical and pathologic diagnoses.
authors.affiliation: Texas Children's Hospital, Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine.
authors.forename: Sara C
authors.initials: SC
authors.lastname: Fallon
authors.affiliation: Texas Children's Hospital, Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Kim
authors.affiliation: Texas Children's Hospital, Surgical Outcomes Center, Division of Pediatric Surgery.
authors.forename: Charlene A
authors.initials: CA
authors.lastname: Hallmark
authors.affiliation: Texas Children's Hospital, Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Carpenter
authors.affiliation: Texas Children's Hospital, Department of Pathology, Baylor College of Medicine.
authors.forename: Karen W
authors.initials: KW
authors.lastname: Eldin
authors.affiliation: Texas Children's Hospital, Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine.
authors.forename: Monica E
authors.initials: ME
authors.lastname: Lopez
authors.affiliation: Texas Children's Hospital, Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine.
authors.forename: David E
authors.initials: DE
authors.lastname: Wesson
authors.affiliation: Texas Children's Hospital, Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine.
authors.forename: Mary L
authors.initials: ML
authors.lastname: Brandt
authors.affiliation: Texas Children's Hospital, Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine. Electronic address: rxrodri2@texaschildrens.org.
authors.forename: J
authors.initials: J
authors.lastname: Ruben Rodriguez
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D001062:Appendectomy; D001064:Appendicitis / Q000175:diagnosis* / Q000601:surgery; D002648:Child; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D015203:Reproducibility of Results; D055815:Young Adult
keywords: Appendicitis; Pathology; Pediatrics; Quality improvement