- Design
- Video-based interobserver agreement study
- Population
- 89 Danish surgeons and trainees grading 30 laparoscopic appendicectomy videos
- Primary outcome
- Agreement on appendicitis grade and postoperative antibiotics
- Effect
- κ 0.72 normal vs appendicitis; κ 0.66 complex; antibiotic agreement 81% for gangrenous
Eighty-nine surgeons and trainees from seven Danish hospitals watched laparoscopy videos of 30 patients with suspected appendicitis and graded each appendix as normal, phlegmonous, gangrenous or perforated, then said whether they would give postoperative antibiotics (World Journal of Surgery, 18 October 2026).
Agreement was moderate for separating a normal appendix from appendicitis (κ 0.72, 95% CI 0.61-0.84) and for identifying complex appendicitis (κ 0.66, 0.52-0.80). Agreement on antibiotics was high for phlegmonous (96%) and perforated (99.7%) cases but lower for gangrenous (81%), the grade where the decision is least settled.
The practical point is that 'gangrenous' is the category most open to interpretation. Units may reduce variation by agreeing a simple-versus-complex definition and a default antibiotic plan for each, and by photographing the appendix for the record.
- Agree a unit definition of simple versus complex appendicitis and the antibiotic plan for each.
- Treat 'gangrenous' as the grade most likely to be classified differently by a colleague.
- Photograph the appendix and any contamination to support the grading in the record.
- Use the grading to stop antibiotics after simple appendicitis where your protocol allows.
Why it matters
A subjective intraoperative call decides who gets days of antibiotics and a longer stay, and gangrenous is where surgeons disagree most.
The statistics, in plain English
Kappa measures agreement beyond chance: 1 is perfect, 0 is chance. Values around 0.6-0.7 mean surgeons often but not reliably agree.
Read the rest in the app
You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this finding is waiting in it.
Scan to keep reading on your phone. No account needed to start.
Tomorrow morning, before your first patient
One edition a day for general surgery, written by the desk, every claim tied to its paper. Six minutes.
Get the app — free