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Predictors of Failed Laparoscopic Appendectomy in Perforated Appendicitis
J Acute Care Surg 2018;8:59−64
Published online October 30, 2018;  https://doi.org/10.17479/jacs.2018.8.2.59
© 2018 Korean Society of Acute Care Surgery.

Sean Martin, D.O.*, Yijin Wert, B.S.*, Zach Lyon, M.S., Leonardo Geraci, D.O.*

*PinnacleHealth System, Department of General Surgery, Harrisburg, Lake Erie College of Osteopathic Medicine, Lake Erie, PA, USA
Sean Martin, D.O.
PinnacleHealth System, Department of General Surgery, Harrisburg, 4300 Londonderry Rd, Harrisburg, PA 17109, USA
Tel: +1-610-248-3508
Fax: +1-717-657-7555
E-mail: semartin@pinnaclehealth.org
Received May 16, 2017; Revised November 22, 2017; Accepted December 1, 2017.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
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.
Keywords : Appendicitis, Laparoscopic appendectomy, Failed laparoscopic, Open appendectomy, Perforated appendicitis


October 2018, 8 (2)
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