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Predictors of Failed Laparoscopic Appendectomy in Perforated Appendicitis
Sean Martin,Yijin Wert,Zach Lyon,Leonardo Geraci 대한외상중환자외과학회 2018 Journal of Acute Care Surgery Vol.8 No.2
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.
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