Concordance in Intraoperative Surgeons' Opinion in the Diagnosis and Management of Acute Appendicitis: The Role of Training.

Autor: Elisa Z; Pediatric Surgery Unit, Ospedale Infantile Regina Margherita, Città della Salute e della Scienza, Torino, TO, Italy. Electronic address: elisa.zambaiti@hotmail.it., Camilla P; Pediatric Surgery Unit, Azienda Ospedaliero Universitaria di Padova, Padova, PD, Italy; Department of Pediatric Surgery, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, TS, Italy., Giulia M; Pediatric Surgery Unit, Azienda Ospedaliero Universitaria di Padova, Padova, PD, Italy; Umberto Bosio Center for Digestive Diseases, Pediatric Surgery Unit, AO SS Antonio e Biagio e Cesare Arrigo, Alessandria, AL, Italy., Nicola Z; Department of Surgery, Policlinico G.B.Rossi, University of Verona, Verona, VR, Italy., Daniela C; Department of Pediatric Surgery, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, TS, Italy., Francesca G; Complex Operative Unit-Pediatric Surgery, Hospital of Bolzano, Bolzano, BZ, Italy., Marco G; Pediatric Surgery Unit, Ca' Foncello Hospital, Treviso, TV, Italy., Claudio C; Umberto Bosio Center for Digestive Diseases, Pediatric Surgery Unit, AO SS Antonio e Biagio e Cesare Arrigo, Alessandria, AL, Italy., Alessandro P; Pediatric Surgery Unit, Ospedale Infantile Regina Margherita, Città della Salute e della Scienza, Torino, TO, Italy., Fabio B; Pediatric Surgery Unit, Presidio Ospedaliero Santa Chiara, Trento, TN, Italy., Antoniello LM; Pediatric Surgery Unit, Azienda Ospedaliero Universitaria di Padova, Padova, PD, Italy., Piergiorgio G; Pediatric Surgery Unit, Azienda Ospedaliero Universitaria di Padova, Padova, PD, Italy.
Jazyk: angličtina
Zdroj: Journal of surgical education [J Surg Educ] 2024 Aug; Vol. 81 (8), pp. 1083-1088. Date of Electronic Publication: 2024 Jun 22.
DOI: 10.1016/j.jsurg.2024.05.004
Abstrakt: Objective: Acute appendicitis is a wide spectrum disease, from simple inflammation to evident intestinal perforation. The correct interpretation of the degree of inflammation is crucial to guarantee appropriate treatment and adherence to protocols and guidelines. In order to investigate this concordance, the authors compared the definition of appendicitis and the predicted treatment among all surgeons affiliated to a single Pediatric Surgery School (consisting of 8 different centers).
Design: Twenty-two short recordings of intra-operative manipulation of appendices were shown to 56 surgeons, blindly to clinical information. Four items were collected and analyzed: classification of appendicitis, type and length of predicted antibiotic therapy, day of re-alimentation. Data were analyzed to identify the concordance kappa coefficient, stratified according to expertise of the responding surgeon.
Results: The 1232 evaluations obtained in all valued items low overall concordance. Subgroup analysis identified a good agreement between younger surgeons only in the choice of antibiotic (k 0.47). However, if the centers were divided between University and non-University Hospitals, a strong agreement was found in the former both for classification (k 0.45 vs 0.32) and type of antibiotic (k 0.42 vs 0.24).
Conclusions: The overall concordance between surgeons in different centers in the diagnostic classification and predicted treatment of appendicitis is quite low. University Hospital have a highest concordance in both items at all levels of expertise; it might be postulated that teaching to younger surgeon increase the comparison between experts and finally the concordance and adherence to protocols within the center.
(Copyright © 2024 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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