Contemporary Predictors of Conversion from Laparoscopic to Open Appendectomy

Wagner, Patrick; Eachempati, Soumitra R.; Aronova, Anna; Hydo, Lynn J.; Pieracci, Frederic M.; Bartholdi, Marie; Umunna, Ben-Paul; Shou, Jian; Barie, Philip S.

doi:10.1089/sur.2010.079

Cited by 23 publications

(24 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…We assumed that all appendectomies were completed laparoscopically, in line with modern case series describing very low rates of conversion to open appendectomy for uncomplicated appendicitis. 34–37 We assumed that all NOM failures or recurrences underwent laparoscopic appendectomy (i.e., no further attempts at NOM were made). All patients with complicated failures or recurrences were assumed to undergo percutaneous drain placement by interventional radiology followed by interval appendectomy.…”

Section: Methodsmentioning

confidence: 99%

Operative Versus Nonoperative Management of Appendicitis: A Long-Term Cost Effectiveness Analysis

Sceats

Coughran

et al. 2019

MDM Policy & Practice

View full text Add to dashboard Cite

Background. Recent clinical trials suggest that nonoperative management (NOM) of patients with acute, uncomplicated appendicitis is an acceptable alternative to surgery. However, limited data exist comparing the long-term cost-effectiveness of nonoperative treatment strategies. Design. We constructed a Markov model comparing the cost-effectiveness of three treatment strategies for uncomplicated appendicitis: 1) laparoscopic appendectomy, 2) inpatient NOM, and 3) outpatient NOM. The model assessed lifetime costs and outcomes from a third-party payer perspective. The preferred strategy was the one yielding the greatest utility without exceeding a $50,000 willingness-to-pay threshold. Results. Outpatient NOM cost $233,700 over a lifetime; laparoscopic appendectomy cost $2500 more while inpatient NOM cost $7300 more. Outpatient NOM generated 24.9270 quality-adjusted life-years (QALYs), while laparoscopic appendectomy and inpatient NOM yielded 0.0709 and 0.0005 additional QALYs, respectively. Laparoscopic appendectomy was cost-effective compared with outpatient NOM (incremental cost-effectiveness ratio $32,300 per QALY gained); inpatient NOM was dominated by laparoscopic appendectomy. In one-way sensitivity analyses, the preferred strategy changed when varying perioperative mortality, probability of appendiceal malignancy or recurrent appendicitis after NOM, probability of a complicated recurrence, and appendectomy cost. A two-way sensitivity analysis showed that the rates of NOM failure and appendicitis recurrence described in randomized trials exceeded the values required for NOM to be preferred. Limitations. There are limited NOM data to generate long-term model probabilities. Health state utilities were often drawn from single studies and may significantly influence model outcomes. Conclusion. Laparoscopic appendectomy is a cost-effective treatment for acute uncomplicated appendicitis over a lifetime time horizon. Inpatient NOM was never the preferred strategy in the scenarios considered here. These results emphasize the importance of considering long-term costs and outcomes when evaluating NOM.

show abstract

Section: Methodsmentioning

confidence: 99%

Operative Versus Nonoperative Management of Appendicitis: A Long-Term Cost Effectiveness Analysis

Sceats

Coughran

et al. 2019

MDM Policy & Practice

View full text Add to dashboard Cite

show abstract

“…They also accounted for the inexperience of the operating surgeon. 14 Hyperbilirubinemia has been used as a predictor for appendicular perforation. Elevation of total serum bilirubin without elevation of liver enzymes is considered as a predictive factor for appendicular perforation.…”

Section: Discussionmentioning

confidence: 99%

A study of pre-operative predictors for conversion to open surgery in emergency laparoscopic appendectomy

2020

View full text Add to dashboard Cite

Background: Acute appendicitis is one of the most common emergencies encountered by surgeons. Although laparoscopic appendectomy is the preferred approach complicated appendicitis with a mass, abscess or perforation do present with a challenge to the operating surgeon compelling him to convert to open surgery. Our study aimed at identifying pre-operative factors that would help us predict the risk of conversion to open surgery.Methods: This was a prospective analytical study. All cases admitted over a period of one year undergoing emergency appendectomy were included in the study. The duration of history, clinical presentation, laboratory and radiological investigations were noted. The reason for conversion to open surgery was recorded. The post-operative stay and complications were analyzed.Results: A total of 160 patients fulfilling the inclusion criteria were included in the study. The mean age was 33.78 years with a male preponderance of 58%. The duration of history, clinical and radiological evidence of complicated appendicitis and peritonitis, total leucocyte count and serum bilirubin levels were identified as pre-operative predictors for risk of conversion to open surgery from laparoscopic appendectomy.Conclusions: These predictors are useful in predicting conversion to open surgery in laparoscopic emergency appendectomy. In these cases, proceeding with an open surgical approach may be beneficial to the patient in reducing operative time, cost, hospital stay and complications as laparoscopic approach may prove to be unsuccessful. This would help in enhanced communication between the surgeon and the patient with respect to the outcome and prognosis.

show abstract

“…The conversion rate for laparoscopic appendectomy ranges between 0% and 47% [14][15][16][17][18]. Factors associated with the risk for conversion are: comorbidity presence, retrocecal position of the appendix, diffuse peritonitis and appendicular abscess [19][20][21][22]. In this study, one conversion was done due to the severity of the inflammatory process.…”

Section: Discussionmentioning

confidence: 99%

Complications after Laparoscopic Appendectomy for Complicated Appendicitis

Nikolovski¹,

Tahir²,

Mladenovikj³

2020

View full text Add to dashboard Cite

Background. Laparoscopic appendectomy is established method in the treatment of complicated appendicitis. Certain advantages of the technique do not fulfill the expectations for its superiority over the open appendectomy as when it is used for uncomplicated appendicitis. This is generally caused because of the high variety of postoperative complications reported in different series for complicated appendicitis. Material and methods. This prospective interventional clinical study analyzes 61 patients operated with laparoscopic and open appendectomy due to complicated appendicitis, with an end point of comparing the intra and postoperative complications in both groups. Results. Conversion in open appendectomy was forced in one patient (1.63%). The operative time was significantly shorter in the laparoscopic group (p = 0.048). Wound infection was significantly predominant in the open group (p = 0.045). Postoperative intraabdominal abscess occurred in one patient in the laparoscopic group (p = 0.52). The overall morbidity was 26.2% (7 patients in the laparoscopic, and 9 in the open group; p = 0.59). Length of stay was significantly shorter in the laparoscopic group (p = 0.00001). Conclusion. Certain significant advantages of the laparoscopic appendectomy as low incidence of wound infection, short hospitalization, less postoperative pain and faster socialization makes the laparoscopy up to date method in the treatment of complicated appendicitis.

show abstract

Contemporary Predictors of Conversion from Laparoscopic to Open Appendectomy

Cited by 23 publications

References 16 publications

Operative Versus Nonoperative Management of Appendicitis: A Long-Term Cost Effectiveness Analysis

Operative Versus Nonoperative Management of Appendicitis: A Long-Term Cost Effectiveness Analysis

A study of pre-operative predictors for conversion to open surgery in emergency laparoscopic appendectomy

Complications after Laparoscopic Appendectomy for Complicated Appendicitis

Contact Info

Product

Resources

About