Identification of preoperative risk factors associated with the conversion of laparoscopic to open appendectomies

Abstract

Background: One of the most frequent surgical emergencies in the world is acute appendicitis. In recent years, laparoscopic appendectomy has been the treatment of choice for adult patients because of its widespread acceptability. This study sought to assess the preoperative risk factors for conversion as well as the results of adult patients who had laparoscopic to open appendectomy conversion. Patients and Methods: This retrospective analysis involved 100 patients who underwent laparoscopic appendectomy and had a clinical diagnosis of acute appendicitis. Patients were all 18 years old and above. Patient demographics, comorbidities, preoperative laboratory results, computed tomography, and ultrasound findings, surgical time, intraoperative findings, need for conversion, duration of hospital stay, postoperative morbidity, and readmissions were all gathered for study. Results: Of the participants in our study, 11% had converted from a laparoscopic to an open approach. According to univariate logistic regression analysis, there were several significant risk factors for conversion, including intra-abdominal fluid, appendicular perforation, appendicular necrosis or gangrene, perithyphilitic abscess, peritonitis, high white blood cell (WBCs) count, high BMI, patients with high American Society of Anesthesiologists score, diabetes mellitus, and high C-reactive protein (CRP). Only high WBC count, high CRP, appendicular perforation, appendicular necrosis or gangrene, perithyphilitic abscess, and peritonitis were identified to be significant risk variables of conversion on multivariate logistic regression analysis. Conclusion: The laparoscopic method is an effective treatment for most patients with acute appendicitis. High preoperative WBC count and CRP levels, as well as radiographic abnormalities (perforation, necrosis or gangrene, perithyphilitic abscess, and peritonitis), were the preoperative independent risk factors for the requirement for conversion.