Update Course Rewind: Perforated Appendicitis 2019

CT scan reviewers (6 surgeons including 2 fellows and 2 radiologists) were only 72% accurate in distinguishing perforated from non-perforated appendicitis when reviewing 200 CT scans

Among 62 attending surgeons (adult and pediatric, from university, community, and children's hospitals), agreement in defining intraoperative laparoscopic images as perforated or non-perforated appendicitis was 27%

Inter and intra-observer variability in assessing perforation from intraoperative images was close to chance alone, with surgeons not agreeing with themselves when shown the same image flipped and rotated

A standardized definition of perforated appendicitis as a hole in the appendix or a fecalith in the abdomen was implemented at one hospital

Patients without a hole in the appendix or fecalith in the abdomen had an incidence of postoperative abscess less than 5%

After implementing a standardized definition for perforated appendicitis, the non-perforation abscess rate decreased and the perforation abscess rate increased, suggesting previous misclassification

In a randomized trial with 110 patients per arm, irrigation with minimum 500cc (average 850cc) showed no difference in postoperative abscess rate, length of stay, hospital cost, or operative time compared to no irrigation

A study comparing standardized large-volume irrigation (3-12L in small focused aliquots) to surgeon preference showed 0% abscess rate with standardized irrigation versus 19% with surgeon discretion

A 2018 meta-analysis comparing suction alone versus irrigation in children and adults found no difference in postoperative abscess rates