J Acute Care Surg.  2018 Oct;8(2):59-64. 10.17479/jacs.2018.8.2.59.

Predictors of Failed Laparoscopic Appendectomy in Perforated Appendicitis

• Martin S
• Wert Y
• Lyon Z
• Geraci L

• KMID: 2434939
• DOI: http://doi.org/10.17479/jacs.2018.8.2.59

Abstract

PURPOSE
A recent internal review of a community-based hospital system revealed a 19.19% rate of conversion from a laparoscopic appendectomy to an open procedure. This study examined the preoperative risk factors for failed laparoscopic appendectomy requiring a conversion to a laparotomy.
METHODS
A total of 198 patients presented with perforated appendicitis. Perforation was defined as a computed tomography (CT) scan interpretation, pathology findings, or surgical findings. Of these patients, 161 underwent a laparoscopic appendectomy or laparoscopy converted to an open procedure. The preoperative risk factors in the two groups were compared through a retrospective chart review.
RESULTS
Through multivariant analysis, age greater than 45 was the greatest risk factor for the need to convert to an open procedure with an odds ratio (OR) of 3.51. A CT scan read of perforation was associated with a significant 2.65 OR. The C-reactive protein was 19.82 mg/L in the failed laparoscopic cases and 9.96 mg/L in the laparoscopic cases.
CONCLUSION
Patients older than 45 years old with a CT radiologist's read of a perforation in multivariant analysis have an increased risk of failed laparoscopic surgery requiring conversion to open surgery.

Keyword

Appendicitis; Laparoscopic appendectomy; Failed laparoscopic; Open appendectomy; Perforated appendicitis

MeSH Terms

Appendectomy*
Appendicitis*
C-Reactive Protein
Conversion to Open Surgery
Humans
Laparoscopy
Laparotomy
Odds Ratio
Pathology
Retrospective Studies
Risk Factors
Tomography, X-Ray Computed
C-Reactive Protein