An Evaluated Preoperative C-Reactive Protein Level as a Predictor of Difficult Laparoscopic Appendectomy

To determine the diagnostic accuracy of elevated preoperative C-reactive protein (CRP) level in predicting a difficult laparo- scopic appendectomy (LA).

A descriptive study. Place and Duration of the Study: Department of General Surgery, Dr Ruth, K. M. Pfau Civil Hospital, Dow University of Health Sciences, Karachi, Pakistan, from June to November 2021.

Patients operated for LA underwent baseline investigations and preliminary anaesthesia fitness. Intraoperative findings, including difficult dissection due to dense adhesions, were recorded by a primary surgeon on postoperative notes. Serum CRP level, specificity, sensitivity, diagnostic accuracy, positive predictive value (PPV), and negative predictive value (NPV) were measured. ROC curve was plotted, and the area under the curve (AUC) was utilised. An independent-sample t-test was used to compare mean CRP in patients who underwent laparoscopy-corrected-to-open appendectomy with those who underwent LA. The Chi-square test was used to compare the differences in the proportion of conversion to open surgery from LA and between CRP levels (<220 vs. ≥220 mg/L).

The mean age of the 181 patients was 39.21 ± 10.90 years. There were 87 (48.07%) males and 94 (51.93%) females. The cut-off CRP levels were 220 mg/L for predicting conversion to open appendectomy from LA. The percentages of PPV, NPV, accuracy, sensitivity, and specificity of CRP ≥220 mg/L were 86.96%, 93.26%, 93.02%, 87.37%, and 90.01%, respectively. The area under the receiver operating characteristic curve (AUROC) for the said study model was 0.941, with 95% confidence interval of 0.91 to 0.97.

Elevated preoperative CRP level is a significant predictor of difficult LA. The CRP level aids in selecting patients for early discharge and reducing unnecessary investigations.

Appendicitis, Laparoscopic appendectomy, C-reactive protein level.