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Conversion from laparoscopic to open appendectomy: decreased risk at dedicated children’s hospitals

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Abstract

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.

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Funding

No funding was received for this research.

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Authors and Affiliations

  1. Department of Pediatric Surgery, Mott Children’s Hospital, University of Michigan, Ann Arbor, MI, 48109, USA

    Kevin N. Johnson

  2. Mayo Clinic, Phoenix, AZ, USA

    Maria Linnaus

  3. Phoenix Children’s Hospital, Phoenix, AZ, USA

    David M. Notrica

Authors
  1. Kevin N. Johnson
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  2. Maria Linnaus
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  3. David M. Notrica
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Corresponding author

Correspondence to Kevin N. Johnson.

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The authors declare that they have no conflict of interest.

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This article does not contain any studies with human participants or animals performed by any of the authors.

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Johnson, K.N., Linnaus, M. & Notrica, D.M. Conversion from laparoscopic to open appendectomy: decreased risk at dedicated children’s hospitals. Pediatr Surg Int 34, 873–877 (2018). https://doi.org/10.1007/s00383-018-4297-2

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  • DOI: https://doi.org/10.1007/s00383-018-4297-2

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