Title | Conversion-to-open in laparoscopic appendectomy: A cohort analysis of risk factors and outcomes. |
Publication Type | Journal Article |
Year of Publication | 2017 |
Authors | Finnerty BM, Wu X, Giambrone GP, Gaber-Baylis LK, Zabih R, Bhat A, Zarnegar R, Pomp A, Fleischut P, Afaneh C |
Journal | Int J Surg |
Volume | 40 |
Pagination | 169-175 |
Date Published | 2017 Apr |
ISSN | 1743-9159 |
Keywords | Acute Disease, Adolescent, Adult, Aged, Appendectomy, Appendicitis, Female, Humans, Laparoscopy, Male, Middle Aged, Retrospective Studies, Risk Factors, Young Adult |
Abstract | BACKGROUND: Identifying risk factors for conversion from laparoscopic to open appendectomy could select patients who may benefit from primary open appendectomy. We aimed to develop a predictive scoring model for conversion from laparoscopic to open based on pre-operative patient characteristics. METHODS: A retrospective review of the State Inpatient Database (2007-2011) was performed using derivation (N = 71,617) and validation (N = 143,235) cohorts of adults ≥ 18 years with acute appendicitis treated by laparoscopic-only (LA), conversion from laparoscopic to open (CA), or primary open (OA) appendectomy. Pre-operative variables independently associated with CA were identified and reported as odds ratios (OR) with 95% confidence intervals (CI). A weighted integer-based scoring model to predict CA was designed based on pre-operative variable ORs, and complications between operative subgroups were compared. RESULTS: Independent predictors of CA in the derivation cohort were age ≥40 (OR 1.67; CI 1.55-1.80), male sex (OR 1.25; CI 1.17-1.34), black race (OR 1.46; CI 1.28-1.66), diabetes (OR 1.47; CI 1.31-1.65), obesity (OR 1.56; CI 1.40-1.74), and acute appendicitis with abscess or peritonitis (OR 7.00; CI 6.51-7.53). In the validation cohort, the CA predictive scoring model had an optimal cutoff score of 4 (range 0-9). The risk of conversion-to-open was ≤5% for a score <4, compared to 10-25% for a score ≥4. On composite outcomes analysis controlling for all pre-operative variables, CA had a higher likelihood of infectious/inflammatory (OR 1.44; CI 1.31-1.58), hematologic (OR 1.31; CI 1.17-1.46), and renal (OR 1.22; CI 1.06-1.39) complications compared to OA. Additionally, CA had a higher likelihood of infectious/inflammatory, respiratory, cardiovascular, hematologic, and renal complications compared to LA. CONCLUSIONS: CA patients have an unfavorable complication profile compared to OA. The predictors identified in this scoring model could help select for patients who may benefit from primary open appendectomy. |
DOI | 10.1016/j.ijsu.2017.03.016 |
Alternate Journal | Int J Surg |
PubMed ID | 28285058 |