Imran Jonathan B, Madni Tarik D, Minshall Christian T, Mokdad Ali A, Subramanian Madhu, Clark Audra T, Phelan Herb A, Cripps Michael W
Division of Burns, Trauma, and Critical Care, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas.
Division of Burns, Trauma, and Critical Care, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas.
J Surg Res. 2017 Jun 15;214:197-202. doi: 10.1016/j.jss.2017.02.051. Epub 2017 Mar 6.
Despite its utilization, the intraoperative (IO) assessment of complicated appendicitis (CA) is subjective. The histopathologic (HP) diagnosis should be the gold standard in identifying patients with CA; however, it is not immediately available to guide postoperative management. The objective of this study was to identify predictors of an HP diagnosis of CA.
A retrospective review of all patients who underwent appendectomy at our institution from 2011-2013 was conducted. CA was defined by perforation or abscess on pathology report. Predictors of an HP diagnosis of CA were evaluated using a multivariable regression model.
A total of 239 of 1066 patients had CA based on IO assessment, whereas 143 of 239 patients (60%) had CA on HP and IO assessment. On multivariable analysis, an IO diagnosis of CA was associated with an HP diagnosis of CA (odds ratio [OR]: 10.92; 95% confidence interval [CI]: 7.19-16.58). Other risk factors were age (OR: 1.28; 95% CI: 1.09-1.49), number of days of pain (OR: 1.20; 95% CI: 1.07-1.37), increased heart rate (OR: 1.14; 95% CI: 1.02-1.26), appendix size (OR: 1.09; 95% CI: 1.03-1.16), and an appendicolith (OR: 1.74; 95% CI: 1.12-2.71) on preoperative CT imaging.
In addition to age, increased heart rate, pain duration, appendix size and appendicolith, the IO assessment is also associated with an HP diagnosis of CA; however, 40% of patients were incorrectly classified. Using these predictors with improved IO grading may achieve more accurate diagnosis of CA.
尽管术中对复杂性阑尾炎（CA）的评估已被广泛应用，但该评估具有主观性。组织病理学（HP）诊断应是识别CA患者的金标准；然而，它并不能立即用于指导术后管理。本研究的目的是确定HP诊断为CA的预测因素。
对2011年至2013年在本机构接受阑尾切除术的所有患者进行回顾性研究。CA通过病理报告中的穿孔或脓肿来定义。使用多变量回归模型评估HP诊断为CA的预测因素。
在1066例患者中，基于术中评估有239例患有CA，而在这239例患者中，143例（60%）在HP和术中评估中均患有CA。多变量分析显示，术中诊断为CA与HP诊断为CA相关（比值比[OR]：10.92；95%置信区间[CI]：7.19 - 16.58）。其他危险因素包括年龄（OR：1.28；95% CI：1.09 - 1.49）、疼痛天数（OR：1.20；95% CI：1.07 - 1.37）、心率加快（OR：1.14；95% CI：1.02 - 1.26）、阑尾大小（OR：1.09；95% CI：1.03 - 1.16）以及术前CT影像显示的阑尾粪石（OR：1.74；95% CI：1.12 - 2.71）。
除年龄、心率加快、疼痛持续时间、阑尾大小和阑尾粪石外，术中评估也与HP诊断为CA相关；然而，40%的患者被错误分类。使用这些预测因素并改进术中分级可能实现对CA更准确的诊断。
