Risk factors for conversion from laparoscopic appendectomy to open appendectomy: A retrospective analysis of single-center experience.

Abstract

Background: Acute appendicitis (AA) is one of the most common causes of surgical acute abdomen. Currently, laparoscopic appendectomy (LA) is the most frequently preferred surgical approach. As with all laparoscopic procedures, the possibility of conversion to open surgery also exists in LA. This study aims to identify the risk factors associated with conversion to open appendectomy (OA) during the laparoscopic management of AA.

Methods: This retrospective case-control study included 445 patients who underwent LA for AA between 2018 and 2023. Patients were divided into two groups based on whether conversion to OA was required during the laparoscopic procedure. Preoperative demographic, clinical, and perioperative data were evaluated. Both univariate and multivariate analyses were performed.

Results: The median age of the 445 patients included in the study was 34 years (interquartile range: 25-49). Of these, 58.2% were male. The overall conversion rate to open surgery was 3.8%. In univariate analyses, factors such as age (p=0.002), the American Society of Anesthesiologists (ASA) score (p=0.011), time of arrival at the emergency department (p<0.001), C-reactive protein (CRP) level (p<0.001), amylase level (p=0.012), Malatya Complicated Appendicitis Prediction Score (MCAPS) ≥6 (p<0.001), and presence of complicated appendicitis (p<0.001) were associated with conversion. However, in multivariate analyses, only an MCAPS score of 6 or higher (p=0.034) was identified as an independent risk factor for conversion.

Conclusion: Since conversion to OA is sometimes unavoidable in the management of AA, clinicians may benefit from using the easily applicable MCAPS to predict the likelihood of conversion. This scoring system may also assist in considering primary OA when appropriate.