Laparoscopic Appendectomy Conversion Rates Two Decades Later: An Analysis of Surgeon and Patient-Specific Factors Resulting in Open Conversion

Background. The role of laparoscopy in appendicitis has gained increased popularity but remains controversial. Despite more than 20 y of experience in laparoscopy, the nationwide laparoscopic appendectomy (LA) conversion rate is reportedly 8.6%. We sought to analyze the impact of patient-specific and surgeon-specific factors that may contribute to open conversion during LA. Materials and Methods. A retrospective analysis of 745 LAs (49.9% females and 50.1% males; average age of 37.8 y performed at a large tertiary community teaching hospital over a 5-y period (May 2004-October 2008) was performed. Results. The overall conversion rate for the study period was 4.16% (n = 31). The most common reason for open conversion was severe acute inflammation (38.7%). Among converted cases, 77.42% had no prior abdominal surgery and only 25.81% of cases were converted due to adhesions. Females and patients >= 65-y-old had a higher likelihood of open conversion (4.30% versus 4.02%, P < 0.99 and 9.26% versus 3.76%, P < 0.1107). The overall conversion rate of cases performed by high-volume surgeons (>= 50 total cases) in comparison to low-volume surgeons (10-49 total cases) was higher (4.86% versus 3.30%, P < 0.39). Conversion rates were lower among surgeons who completed residency training after 1990 (3.72% versus 4.35%, P < 0.82) and those with fellowship training (1.42% versus 5.18%, P < 0.034). Conclusions. Laparoscopic conversion continues to gain popularity and remains the gold standard procedure for appendectomy. Older patients have a higher likelihood of conversion with severe acute inflammation being the most common reason for conversion. Additional minimally invasive fellowship training was the only surgeon-specific factor that significantly impacted conversion rate. (C) 2012 Elsevier Inc. All rights reserved.