Contemporary predictors of conversion from laparoscopic to open appendectomy

Area of Science:

• Surgical Innovation
• Gastrointestinal Surgery
• Medical Informatics

Background:

• Laparoscopic appendectomy (LA) is a common procedure for acute appendicitis.
• Understanding conversion rates from LA to open appendectomy is crucial for surgical planning and patient outcomes.

Purpose of the Study:

• To determine the contemporary conversion rate from LA to open appendectomy.
• To identify pre-operative factors associated with conversion from LA.

Main Methods:

• Retrospective review of 941 LAs for suspected acute appendicitis.
• Analysis of patient characteristics, clinical features, CT findings, and operative results.
• Multivariable logistic regression to identify independent predictors of conversion.

Main Results:

• The overall conversion rate was 4.1% and remained stable over the study period.
• Univariable analysis identified numerous factors associated with conversion.
• Advanced age, higher ASA score, CT inflammation grade ≥ 4, and surgeon inexperience were independent predictors of conversion.

Conclusions:

• The conversion rate for LA is approximately 4% and has not significantly changed.
• Advanced age, ASA score >2, surgeon inexperience, and severe CT inflammation predict conversion.
• Considering open appendectomy directly in high-risk cases may improve efficiency and reduce morbidity.