The Variable Definition of "Negative Appendicitis" Remains a Surgical Challenge.

IF 1.3 4区 医学 Q3 PATHOLOGY Pediatric and Developmental Pathology Pub Date : 2024-06-06 DOI:10.1177/10935266241255281
Hetal Patel, Mohamed Kamel, Eden Cooper, Claire Bowen, Ingo Jester
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Abstract

Aim: Acute appendicitis (AA) is treated primarily surgically with histopathology being the gold standard for confirmation of appendicitis and reported rates of negative appendicectomies (NA) ranging between 3.2% and 19% worldwide and 15.9-20.6% in the UK. NA rates are frequently used to identify poor performing centers as part of a Model Health System and form an integral part of appendicitis scoring systems. This study aims to evaluate the prevalence of negative appendicectomies within our institution and critically analyze the appropriateness of its use as a quality metric and its impact on clinical practice and research.

Patients and methods: Data analysis from a prospective dataset of pediatric appendicitis patients between 2015 and 2021 in a tertiary center in the UK was performed. Detailed analysis of negative appendicectomies was performed and further stratified by two distinct age and gender groups looking at the incidence of NA and the classification of non-histologically normal appendix specimens.

Results: In our series, 819 patients met inclusion criteria, 736 (89.9%) had acute appendicitis. Our overall institutional negative appendicectomy rate was 10.1% (83 patients) with the breakdown as follows: 65 histologically normal appendix (7.9%), 10 Enterobius vermicularis, 3 eosinophilic appendicitis, 2 neoplasms, 1 isolated faecolith, 1 fibrous obliteration of the lumen, and 1 peri-appendiceal inflammation.

Conclusion: Our negative appendicectomy rate is below established UK pediatric NA rates. This rate ranges from 7.9% to 10.1% depending on the definition of NA utilized. A single standard pathological definition for histological acute appendicitis is required when being used as a comparative quality metric. Centers engaged in clinical research should be aware of variations in NA definitions both in scoring systems and individual centers to avoid skewing derived results.

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阴性阑尾炎 "的多变定义仍是外科手术的挑战。
目的:急性阑尾炎(AA)主要通过手术治疗,组织病理学是确认阑尾炎的金标准,据报道,全球阑尾切除术(NA)阴性率在 3.2% 到 19% 之间,英国为 15.9%-20.6%。作为示范医疗系统的一部分,阴性阑尾切除率常用于识别表现不佳的中心,也是阑尾炎评分系统的一个组成部分。本研究旨在评估我院阑尾切除术阴性率的发生率,并批判性地分析将其作为质量指标的适当性及其对临床实践和研究的影响:对英国一家三级中心2015年至2021年间小儿阑尾炎患者的前瞻性数据集进行了数据分析。对阴性阑尾切除术进行了详细分析,并按两个不同的年龄和性别组进一步分层,研究NA的发生率和非组织学正常阑尾标本的分类:在我们的系列研究中,有 819 名患者符合纳入标准,其中 736 人(89.9%)患有急性阑尾炎。我院阑尾切除术的总体阴性率为 10.1%(83 例患者),细分如下:其中 65 例阑尾组织学正常(7.9%),10 例蚯蚓肠炎,3 例嗜酸性粒细胞性阑尾炎,2 例肿瘤,1 例孤立性粪石,1 例管腔纤维性阻塞,1 例阑尾周围炎:结论:我们的阑尾切除术阴性率低于英国儿科NA的既定比率。结论:我们的阑尾切除阴性率低于英国儿科的既定阴性率,这一比率从7.9%到10.1%不等,取决于所采用的NA定义。在将组织学急性阑尾炎作为质量比较指标时,需要一个单一的标准病理定义。从事临床研究的中心应注意评分系统和各中心对NA定义的差异,以避免得出的结果出现偏差。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
3.70
自引率
5.30%
发文量
59
审稿时长
6-12 weeks
期刊介绍: The Journal covers the spectrum of disorders of early development (including embryology, placentology, and teratology), gestational and perinatal diseases, and all diseases of childhood. Studies may be in any field of experimental, anatomic, or clinical pathology, including molecular pathology. Case reports are published only if they provide new insights into disease mechanisms or new information.
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