Department of Surgery, New York-Presbyterian Hospital and Weill Cornell Medical College, New York, New York 10065, USA.
Surg Infect (Larchmt). 2011 Aug;12(4):261-6. doi: 10.1089/sur.2010.079. Epub 2011 Jul 26.
We defined the contemporary conversion rate from laparoscopic appendectomy (LA) to open appendectomy and identified pre-operative factors associated with conversion.
Retrospective review of 941 consecutive LAs performed for suspected acute appendicitis in a single urban university hospital between 2000 and 2007. Patient characteristics, clinical features, physical examination findings, laboratory values, computed tomography (CT) findings, surgeon identity, operative findings, and pathologic results were assessed. Categorical variables were compared in patients undergoing LA and those in whom conversion was necessary using the Fisher exact test; the Student t-test was used to compare continuous variables. Multivariable analysis was performed with binomial logistic regression. Statistical significance was established at α = 0.05.
The overall conversion rate was 4.1% and did not change significantly over the course of the study. By univariable analysis, conversion was significantly associated with older age, male gender, American Society of Anesthesiologists (ASA) score >2 points, longer duration of symptoms, rigidity on physical examination, increased percentage of neutrophils on admission white blood cell differential count, extraluminal air on CT, inexperience of the attending surgeon with LA, retrocecal location of the appendix, gross necrosis or perforation, murky or purulent ascites, and microscopic evidence of perforation. By multivariable analysis, advanced age (hazard ratio [HR] 1.02 per year; 95% confidence interval [CI] 1.01-1.04, p = 0.02), ASA score >2 points (HR 11.2; 95% CI 5.6-24.4; p < 0.001), CT inflammation grade ≥ 4 (HR 4.8; 95% CI 1.9-12.3; p = 0.001), and attending surgeon inexperience (HR 7.4; 95% CI 2.6-20.8; p < 0.001) were independent predictors of conversion.
The conversion rate during laparoscopic appendectomy has not changed significantly over the past seven years and remains ~4%. Independent pre-operative predictors of conversion are advanced age, ASA score >2 points, attending surgeon inexperience, and extensive inflammation observed on pre-operative CT scan. Proceeding directly with open appendectomy under these circumstances may reduce operative time, expense, and morbidity.
我们定义了腹腔镜阑尾切除术（LA）转为开腹阑尾切除术的当代转化率，并确定了与转化相关的术前因素。
回顾性分析了 2000 年至 2007 年间在一家单一的城市大学医院对疑似急性阑尾炎进行的 941 例连续 LA 手术。评估了患者特征、临床特征、体格检查结果、实验室值、计算机断层扫描（CT）结果、外科医生身份、手术结果和病理结果。使用 Fisher 精确检验比较接受 LA 和需要转换的患者的分类变量；使用 Student t 检验比较连续变量。使用二项逻辑回归进行多变量分析。统计学意义设定为α=0.05。
总体转化率为 4.1%，在研究过程中没有明显变化。通过单变量分析，转化率与年龄较大、男性、美国麻醉师协会（ASA）评分>2 分、症状持续时间较长、体格检查时僵硬、入院时中性粒细胞百分比增加、CT 上的腔外空气、手术医生经验不足、阑尾后位、肉眼坏死或穿孔、混浊或脓性腹水、穿孔的显微镜证据显著相关。通过多变量分析，年龄较大（每增加 1 年 HR 为 1.02；95%CI 为 1.01-1.04，p=0.02）、ASA 评分>2 分（HR 为 11.2；95%CI 为 5.6-24.4；p<0.001）、CT 炎症程度≥4 级（HR 为 4.8；95%CI 为 1.9-12.3；p=0.001）和手术医生经验不足（HR 为 7.4；95%CI 为 2.6-20.8；p<0.001）是转化的独立预测因素。
过去七年腹腔镜阑尾切除术的转化率没有明显变化，仍保持在~4%。转化的独立术前预测因素是年龄较大、ASA 评分>2 分、手术医生经验不足以及术前 CT 扫描观察到广泛炎症。在这些情况下直接进行开腹阑尾切除术可能会减少手术时间、费用和发病率。
