Journal of Acute Care Surgery 2018;8(2):59-64

doi:10.17479/jacs.2018.8.2.59

Predictors of Failed Laparoscopic Appendectomy in Perforated Appendicitis.

Sean MARTIN 1 ; Yijin WERT ; Zach LYON ; Leonardo GERACI

Affiliations

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Keywords

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

Country

Republic 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.