Conversion from laparoscopic to open appendectomy: decreased risk at dedicated children's hospitals. Pediatr Surg Int 2018 Aug;34(8):873-877
Date
06/22/2018Pubmed ID
29926162DOI
10.1007/s00383-018-4297-2Scopus ID
2-s2.0-85048766418 (requires institutional sign-in at Scopus site) 11 CitationsAbstract
PURPOSE: The advent of laparoscopy has revolutionized surgical practice within the last 30 years. Conversion to open surgery, however, remains necessary at times, even for the most experienced laparoscopic surgeon.
METHODS: The kids' inpatient database was analyzed for 2006, 2009, and 2012 for patients who underwent laparoscopic appendectomy and conversion to open (CPT 470.1 and V64.41, respectively). Variables included in multivariable analysis were determined based on those variables found to have significance on univariate analysis.
RESULTS: A total of 104,865 patients, ages 0-17 years, underwent laparoscopic appendectomy during the three study periods. Of these, 2370 (2.2%) laparoscopic surgeries were converted to open appendectomy. Multivariable logistic regression showed significantly higher rates of conversion amongst patients with peritonitis (OR 6.7, p < 0.001) or abscess (OR 14.3, p < 0.001), obesity (OR 2.02, p < 0.001), age > 13 years (OR 1.53 for ages 13-15, OR 1.77 for ages 16-17, p < 0.001 for both), or cared for at rural hospitals (OR 1.55, p = 0.002). Rates of conversion decreased over time for children at adult hospitals and at urban hospitals, regardless of teaching status (p < 0.001 for both).
CONCLUSION: Risk factors for conversion from laparoscopic to open appendectomy included abscess, peritonitis, increased age, obesity, male gender, socioeconomic status and treatment at a non-pediatric-specific hospital, and the overall rate is decreasing over time.
Author List
Johnson KN, Linnaus M, Notrica DMMESH terms used to index this publication - Major topics in bold
Abdominal AbscessAdolescent
Age Factors
Appendectomy
Appendicitis
Child
Child, Preschool
Conversion to Open Surgery
Female
Hospitals, Pediatric
Hospitals, Rural
Hospitals, Urban
Humans
Infant
Infant, Newborn
Laparoscopy
Male
Obesity
Peritonitis
Retrospective Studies
Sex Factors
