Predictors of Failed Laparoscopic Appendectomy in Perforated Appendicitis.
10.17479/jacs.2018.8.2.59
- Author:
Sean MARTIN
1
;
Yijin WERT
;
Zach LYON
;
Leonardo GERACI
Author Information
1. PinnacleHealth System, Department of General Surgery, Harrisburg, USA. semartin@pinnaclehealth.org
- Publication Type:Original Article
- Keywords:
Appendicitis;
Laparoscopic appendectomy;
Failed laparoscopic;
Open appendectomy;
Perforated appendicitis
- MeSH:
Appendectomy*;
Appendicitis*;
C-Reactive Protein;
Conversion to Open Surgery;
Humans;
Laparoscopy;
Laparotomy;
Odds Ratio;
Pathology;
Retrospective Studies;
Risk Factors;
Tomography, X-Ray Computed
- From:
Journal of Acute Care Surgery
2018;8(2):59-64
- CountryRepublic of Korea
- Language:English
-
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.
