Surgeons' attitudes during laparoscopic appendectomy: do subjective intraoperative assessments affect the choice of peritoneal irrigation? A spin-off analysis from the REsiDENT-1 multicentre prospective observational trial.
Acute appendicitis
Intra-abdominal abscess
Laparoscopic appendectomy
Peritoneal irrigation
Surgical decision-making
Surgical education
Surgical psychology
Journal
Surgical endoscopy
ISSN: 1432-2218
Titre abrégé: Surg Endosc
Pays: Germany
ID NLM: 8806653
Informations de publication
Date de publication:
01 2023
01 2023
Historique:
received:
12
05
2022
accepted:
24
09
2022
pubmed:
29
10
2022
medline:
18
1
2023
entrez:
28
10
2022
Statut:
ppublish
Résumé
Laparoscopic appendectomy (LA) for acute appendicitis (AA) is one of the most performed procedures. The effects of peritoneal lavage (PL) and the reasons to perform it have not been cleared and all meta-analyses didn't show a statistical advantage to prevent infectious complications. This study aims to investigate surgeons' perceptions during LA, comparing intraoperative findings with histological results, and exploring how surgeons' subjectivity influences the decision-making process on PL. Data were extracted from the two-year data lock from REsiDENT-1 registry, a prospective resident-led multicentre observational trial. This study investigates the relationships between PL and postoperative intraabdominal abscesses (pIAA) introducing a classification for AA to standardize the intraoperative grading. We included pre, intra, and postoperative variables. We applied our classification proposal, used a five-point Likert scale (Ls) to assess subjective LA difficulty and ran a concordance analysis between the assessment of AA and histology. Subsequently, a multivariate logistic regression model was built to find factors influencing PL. 561 patients were enrolled from twenty-one hospitals and 51 residents. 542 procedures were included in the logistic regression analysis and 441 in the concordance analysis, due to missing data. PL was used in 222 LA (39, 6%). We discovered a moderate positive monotonic relationship between surgical evaluation and histology, p < 0.001. Despite this, the reliability of the surgeon's assessment of appendicitis is progressively lower for gangrenous and perforated forms. The increasing grade of contamination, the increasing grade of subjective difficulty and the intraoperative finding of a gangrenous or perforated appendicitis were independent predictors of PL. This study shows how surgeons' evaluation of AA severity overestimated more than half of gangrenous or perforated appendices with the perception of a challenging procedure. These perceptions influenced the choice of PL. We proved that the evaluation during LA could be affected by subjectivity with a non-negligible impact on the decision-making process.
Identifiants
pubmed: 36307601
doi: 10.1007/s00464-022-09674-0
pii: 10.1007/s00464-022-09674-0
doi:
Banques de données
ClinicalTrials.gov
['NCT05075252']
Types de publication
Observational Study
Multicenter Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
729-740Investigateurs
Giulia Arianna Abruzzese
(GA)
Francesca Albanesi
(F)
Michele Altomare
(M)
Erika Andreatta
(E)
Ludovica Baldari
(L)
Laura Benuzzi
(L)
Emanuele Bevilaqua
(E)
Alessandro Michele Bonomi
(AM)
Greta Brachetti
(G)
Giulia Cannavale
(G)
Andrea Piero Chierici
(AP)
Stefano P B Cioffi
(SPB)
Riccardo Cirelli
(R)
Gaia Colletti
(G)
Vera D'abrosca
(V)
Piergiorgio Danelli
(P)
Luca Del Prete
(L)
Francesco Di Capua
(F)
Francesca Di Vittorio
(F)
Davide Ferrari
(D)
Luca Ferrario
(L)
Laura Fiore
(L)
Colomba Frattaruol
(C)
Caterina Froiio
(C)
Ludovica Gibelli
(L)
Irene Giusti
(I)
Ugo Giustizieri
(U)
Samuele Grandi
(S)
Stefano Granieri
(S)
Giulio Iacob
(G)
Alessia Kersik
(A)
Pietro Lombardi
(P)
Marco Longhi
(M)
Leonardo Lorusso
(L)
Michele Manara
(M)
Elena Manzo
(E)
Jacopo Nicolo Marin
(JN)
Marianna Maspero
(M)
Valentina Messina
(V)
Pamela Milito
(P)
Mattia Molteni
(M)
Eleonora Monti
(E)
Vincenzo Nicastro
(V)
Giorgio Novelli
(G)
Sissi Paleino
(S)
Silvia Pavesi
(S)
Carolina Perali
(C)
Isabella Pezzoli
(I)
Roberta Ragozzino
(R)
Giuliano Santolamazza
(G)
Luca Scaravilli
(L)
Andrea Spota
(A)
Gilda Tornatore
(G)
Francesco Toti
(F)
Vincenzo Tripodi
(V)
Elisa Vaterlini
(E)
Barbara Vignati
(B)
Informations de copyright
© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.
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