Abstract：
BACKGROUND: The aims of this study were to evaluate the concordance between AAST-CT appendicitis grading criteria, first published in 2014, and surgical findings and to assess the impact of CT staging on the choice of surgical approach.
METHODS: This was a multi-center retrospective case-control study including 232 consecutive patients undergoing surgery for acute appendicitis and who had undergone preoperative CT evaluation between 1 January 2017 and 1 January 2022. Appendicitis severity was classified in 5 grades. For each degree of severity, the surgical outcome between patients undergoing open and surgical approach was compared.
RESULTS: An almost perfect agreement (k = 0.96) was found between CT and surgery in staging acute appendicitis. The vast majority of patients with grade 1 and 2 appendicitis underwent laparoscopic surgical approach and showed low morbidity rate. In patients with grade 3 and 4 appendicitis, laparoscopic approach was adopted in 70% of cases and was associated, if compared to open, with a higher prevalence of postoperative abdominal collections (p = 0.05; fisher\'s exact test) and a significantly lower prevalence of surgical site infections (p = 0.0007; fisher\'s exact test). All the patients with grade 5 appendicitis were treated by laparotomy.
CONCLUSIONS: AAST-CT appendicitis grading system seems to show a relevant prognostic value and a potential impact on the choice of surgical strategy, directing toward a laparoscopic approach in patients with grade 1 and 2, an initial laparoscopic approach, replaceable by the open one, for grade 3 and 4 and an open approach in patients with grade 5.
METHODS: This was a multi-center retrospective case-control study including 232 consecutive patients undergoing surgery for acute appendicitis and who had undergone preoperative CT evaluation between 1 January 2017 and 1 January 2022. Appendicitis severity was classified in 5 grades. For each degree of severity, the surgical outcome between patients undergoing open and surgical approach was compared.
RESULTS: An almost perfect agreement (k = 0.96) was found between CT and surgery in staging acute appendicitis. The vast majority of patients with grade 1 and 2 appendicitis underwent laparoscopic surgical approach and showed low morbidity rate. In patients with grade 3 and 4 appendicitis, laparoscopic approach was adopted in 70% of cases and was associated, if compared to open, with a higher prevalence of postoperative abdominal collections (p = 0.05; fisher\'s exact test) and a significantly lower prevalence of surgical site infections (p = 0.0007; fisher\'s exact test). All the patients with grade 5 appendicitis were treated by laparotomy.
CONCLUSIONS: AAST-CT appendicitis grading system seems to show a relevant prognostic value and a potential impact on the choice of surgical strategy, directing toward a laparoscopic approach in patients with grade 1 and 2, an initial laparoscopic approach, replaceable by the open one, for grade 3 and 4 and an open approach in patients with grade 5.
摘要：
背景：这项研究的目的是评估AAST-CT阑尾炎分级标准之间的一致性，首次发表于2014年，以及手术发现并评估CT分期对手术入路选择的影响。
方法：这是一项多中心回顾性病例对照研究，包括232例接受急性阑尾炎手术的连续患者，这些患者在2017年1月1日至2022年1月1日期间接受了术前CT评估。阑尾炎严重程度分为5级。对于每种严重程度，比较了开放手术和手术入路患者的手术结果.
结果：在急性阑尾炎的分期中，CT和手术几乎完全一致（k=0.96）。绝大多数1级和2级阑尾炎患者接受腹腔镜手术入路，发病率低。在3级和4级阑尾炎患者中，在70％的病例中采用了腹腔镜方法，并且相关，如果与开放相比，术后腹部收集的患病率较高（p=0.05；Fisher精确检验），手术部位感染的患病率明显较低（p=0.0007；Fisher精确检验）。所有5级阑尾炎患者均行开腹手术治疗。
结论：AAST-CT阑尾炎分级系统似乎显示出相关的预后价值和对手术策略选择的潜在影响，针对1级和2级患者的腹腔镜入路，最初的腹腔镜入路，可由开放的，对于3级和4级，对于5级患者采用开放方法。
方法：这是一项多中心回顾性病例对照研究，包括232例接受急性阑尾炎手术的连续患者，这些患者在2017年1月1日至2022年1月1日期间接受了术前CT评估。阑尾炎严重程度分为5级。对于每种严重程度，比较了开放手术和手术入路患者的手术结果.
结果：在急性阑尾炎的分期中，CT和手术几乎完全一致（k=0.96）。绝大多数1级和2级阑尾炎患者接受腹腔镜手术入路，发病率低。在3级和4级阑尾炎患者中，在70％的病例中采用了腹腔镜方法，并且相关，如果与开放相比，术后腹部收集的患病率较高（p=0.05；Fisher精确检验），手术部位感染的患病率明显较低（p=0.0007；Fisher精确检验）。所有5级阑尾炎患者均行开腹手术治疗。
结论：AAST-CT阑尾炎分级系统似乎显示出相关的预后价值和对手术策略选择的潜在影响，针对1级和2级患者的腹腔镜入路，最初的腹腔镜入路，可由开放的，对于3级和4级，对于5级患者采用开放方法。
