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Ann Surg Treat Res. 2017 Aug;93(2):88-97. English. Original Article. https://doi.org/10.4174/astr.2017.93.2.88
Kim HJ , Kim MS , Park JH , Ahn S , Ko Y , Song SY , Woo JY , Lee KH , .
Department of Radiology, Daejin Medical Center, Bundang Jesaeng General Hospital, Seongnam, Korea.
Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea. misung70@gmail.com
Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
Division of Statistics, Medical Research Collaborating Center, Seoul National University Bundang Hospital, Seongnam, Korea.
Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea.
Program in Biomedical Radiation Sciences, Department of Transdisciplinary Studies, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Korea.
Department of Radiology, Hanyang University Hospital, Seoul, Korea.
Department of Radiology, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea.
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 ± 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 (≥3.7 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.

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