Faculty Collaboration Database

Controversy in the classification of appendicitis and utilization of postoperative antibiotics. Surgery 2022 Apr;171(4):1022-1026

Date

11/15/2021

Pubmed ID

34774292

DOI

10.1016/j.surg.2021.10.006

Scopus ID

2-s2.0-85119014738 (requires institutional sign-in at Scopus site)   4 Citations

Abstract

BACKGROUND: There is wide variability and considerable controversy regarding the classification of appendicitis and the need for postoperative antibiotics. This study aimed to assess interrater agreement with respect to the classification of appendicitis and its influence on the use of postoperative antibiotics amongst surgeons and surgical trainees.

METHODS: A survey comprising 15 intraoperative images captured during appendectomy was distributed to surgeons and surgical trainees. Participants were asked to classify severity of disease (normal, inflamed, purulent, gangrenous, perforated) and whether they would prescribe postoperative antibiotics. Statistical analysis included percent agreement, Krippendorff's alpha for interrater agreement, and logistic regression.

RESULTS: In total, 562 respondents completed the survey: 206 surgical trainees, 217 adult surgeons, and 139 pediatric surgeons. For classification of appendicitis, the statistical interrater agreement was highest for categorization as gangrenous/perforated versus nongangrenous/nonperforated (Krippendorff's alpha = 0.73) and lowest for perforated versus nonperforated (Krippendorff's alpha = 0.45). Fourteen percent of survey respondents would administer postoperative antibiotics for an inflamed appendix, 44% for suppurative, 75% for gangrenous, and 97% for perforated appendicitis. Interrater agreement of postoperative antibiotic use was low (Krippendorff's alpha = 0.28). The only significant factor associated with postoperative antibiotic utilization was 16 or more years in practice.

CONCLUSIONS: Surgeon agreement is poor with respect to both subjective appendicitis classification and objective utilization of postoperative antibiotics. This survey demonstrates that a large proportion (59%) of surgeons prescribe antibiotics after nongangrenous or nonperforated appendectomy, despite a lack of evidence basis for this practice. These findings highlight the need for further consensus to enable standardized research and avoid overtreatment with unnecessary antibiotics.

Author List

Buonpane CL, Vacek J, Harris CJ, Salazar Osuna JH, Van Arendonk KJ, Hunter CJ, Goldstein SD

Author

Jose Salazar Osuna MD Assistant Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Anti-Bacterial Agents
Appendectomy
Appendicitis
Appendix
Child
Humans
Postoperative Period
Retrospective Studies