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KMID : 0371420170930020088
Annals of Surgical Treatment and Research
2017 Volume.93 No. 2 p.88 ~ p.97
Meaningful standard of reference for appendiceal perforation: pathology, surgery, or both?
Kim Hyuk-Jung

Kim Mi-Sung
Park Ji-Hoon
Ahn So-Yeon
Ko You-Sun
Song Soon-Young
Woo Ji-Young
Lee Kyoung-Ho
Abstract
Purpose: This retrospective study was aimed to determine if appendiceal perforation identified pathologically but not surgically is clinically meaningful.

Methods: The study consists of 2 parts. First, we reviewed 74 studies addressing appendiceal perforation published in 2012 and 2013. Second, in a cross-sectional study, we classified 1,438 adolescents and adults (mean age, 29.3 ¡¾ 8.4 years; 785 men) with confirmed appendicitis as ¡°nonperforation¡± (n = 1,083, group 1), ¡°pathologically-identified perforation¡± (n = 55, group 2), ¡°surgically-identified perforation¡± (n = 202, group 3), or ¡°pathologically- and surgically-identified perforation¡± (n = 98, group 4). The 4 groups were compared for the frequency of laparoscopic appendectomy and the length of hospital stay using multivariable logistic regression analyses.

Results: The reference standard for appendiceal perforation was frequently missing or inconsistent in the previous studies. Laparoscopic appendectomies were less frequent in groups 3 (52.5%, P = 0.001) and 4 (65%, P = 0.040) than in group 1 (70.7%), while group 2 (73%, P = 0.125) did not significantly differ from group 1. Median hospital stays were 2.9, 3.0, 5.1, and 6.0 days for groups 1?4, respectively. Prolonged hospital stay (¡Ã3.7 days) was more frequent in groups 3 (77.7%, P < 0.001) and 4 (89%, P < 0.001) than in group 1 (23.4%), while group 2 (35%, P = 0.070) did not significantly differ from group 1.

Conclusion: We recommend using surgical rather than pathologic findings as the reference standard for the presence of appendiceal perforation in future investigations.
KEYWORD
Appendicitis, Perforation
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