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.