[Acute appendicitis: diagnostic discrepancies and clinical significance of delayed diagnosis].

OBJECTIVE

To assess consistency between surgeon's diagnosis and pathomorphological data in acute appendicitis, as well as impact of delayed diagnosis on the incidence of complications and length of hospital-stay.

MATERIAL AND

METHODS

A retrospective multiple-center study enrolled 778 patients who underwent appendectomy for acute appendicitis in 2024. A subgroup of 42 patients with delayed diagnosis of acute appendicitis was identified. For statistical analysis of data, chi-square test (χ2), Student's t test (Welch's version, two-sided), odds ratio (OR) with 95% confidence interval (CI) and Cohen's kappa coefficient of agreement (κ) were used. Differences were significant at p<0.05.

RESULTS

Intraoperatively, phlegmonous (70.7%) and gangrenous (27.8%) appendicitis predominated. Agreement between surgeons and pathologists was low (κ=0.322). The diagnosis of "gangrenous appendicitis" established by surgeon was confirmed by pathologists only in 53.7% of cases. A subgroup of patients with delayed diagnosis (5.4% of patients) was characterized by higher incidence of complications (59.5% versus 27.0% in the main group; OR 3.97; 95% CI 2.10-7.51; p<0.001) and prolonged hospital-stay (6.3±3.5 vs. 8.9±6.1 days, p=0.009).

CONCLUSION

Our data indicate a systematic overdiagnosis of severity of appendix inflammation and significant effect of delayed diagnosis on the incidence of postoperative complications and hospital-stay.