Brendan M Finnerty1, Xian Wu2, Gregory P Giambrone3, Licia K Gaber-Baylis4, Ramin Zabih5, Akshay Bhat6, Rasa Zarnegar7, Alfons Pomp8, Peter Fleischut9, Cheguevara Afaneh10. 1. Department of Surgery, New York Presbyterian Hospital - Weill Cornell Medicine, 525 E. 68th Street, New York, NY 10065, United States. Electronic address: bmf9002@nyp.org. 2. Department of Healthcare Policy and Research, Division of Biostatistics and Epidemiology, Weill Cornell Medicine, 402 East 67th Street, New York, NY 10065, United States. Electronic address: xiw2011@med.cornell.edu. 3. Department of Anesthesia, New York Presbyterian Hospital - Weill Cornell Medicine, 525 E. 68th Street, New York, NY 10065, United States. Electronic address: grg2010@med.cornell.edu. 4. Department of Anesthesia, New York Presbyterian Hospital - Weill Cornell Medicine, 525 E. 68th Street, New York, NY 10065, United States. Electronic address: lig3001@med.cornell.edu. 5. Department of Computer Science, Cornell University, 402 Gates Hall, Ithaca, NY 14853, United States. Electronic address: rdz@cs.cornell.edu. 6. Department of Computer Science, Cornell University, 402 Gates Hall, Ithaca, NY 14853, United States. Electronic address: akshayubhat@gmail.com. 7. Department of Surgery, New York Presbyterian Hospital - Weill Cornell Medicine, 525 E. 68th Street, New York, NY 10065, United States. Electronic address: raz2002@med.cornell.edu. 8. Department of Surgery, New York Presbyterian Hospital - Weill Cornell Medicine, 525 E. 68th Street, New York, NY 10065, United States. Electronic address: alp2014@med.cornell.edu. 9. Department of Anesthesia, New York Presbyterian Hospital - Weill Cornell Medicine, 525 E. 68th Street, New York, NY 10065, United States. Electronic address: pmf9003@med.cornell.edu. 10. Department of Surgery, New York Presbyterian Hospital - Weill Cornell Medicine, 525 E. 68th Street, New York, NY 10065, United States. Electronic address: cha9043@med.cornell.edu.
Abstract
BACKGROUND: Identifying risk factors for conversion from laparoscopic to open appendectomy could select patients who may benefit from primary open appendectomy. We aimed to develop a predictive scoring model for conversion from laparoscopic to open based on pre-operative patient characteristics. METHODS: A retrospective review of the State Inpatient Database (2007-2011) was performed using derivation (N = 71,617) and validation (N = 143,235) cohorts of adults ≥ 18 years with acute appendicitis treated by laparoscopic-only (LA), conversion from laparoscopic to open (CA), or primary open (OA) appendectomy. Pre-operative variables independently associated with CA were identified and reported as odds ratios (OR) with 95% confidence intervals (CI). A weighted integer-based scoring model to predict CA was designed based on pre-operative variable ORs, and complications between operative subgroups were compared. RESULTS: Independent predictors of CA in the derivation cohort were age ≥40 (OR 1.67; CI 1.55-1.80), male sex (OR 1.25; CI 1.17-1.34), black race (OR 1.46; CI 1.28-1.66), diabetes (OR 1.47; CI 1.31-1.65), obesity (OR 1.56; CI 1.40-1.74), and acute appendicitis with abscess or peritonitis (OR 7.00; CI 6.51-7.53). In the validation cohort, the CA predictive scoring model had an optimal cutoff score of 4 (range 0-9). The risk of conversion-to-open was ≤5% for a score <4, compared to 10-25% for a score ≥4. On composite outcomes analysis controlling for all pre-operative variables, CA had a higher likelihood of infectious/inflammatory (OR 1.44; CI 1.31-1.58), hematologic (OR 1.31; CI 1.17-1.46), and renal (OR 1.22; CI 1.06-1.39) complications compared to OA. Additionally, CA had a higher likelihood of infectious/inflammatory, respiratory, cardiovascular, hematologic, and renal complications compared to LA. CONCLUSIONS: CA patients have an unfavorable complication profile compared to OA. The predictors identified in this scoring model could help select for patients who may benefit from primary open appendectomy.
BACKGROUND: Identifying risk factors for conversion from laparoscopic to open appendectomy could select patients who may benefit from primary open appendectomy. We aimed to develop a predictive scoring model for conversion from laparoscopic to open based on pre-operative patient characteristics. METHODS: A retrospective review of the State Inpatient Database (2007-2011) was performed using derivation (N = 71,617) and validation (N = 143,235) cohorts of adults ≥ 18 years with acute appendicitis treated by laparoscopic-only (LA), conversion from laparoscopic to open (CA), or primary open (OA) appendectomy. Pre-operative variables independently associated with CA were identified and reported as odds ratios (OR) with 95% confidence intervals (CI). A weighted integer-based scoring model to predict CA was designed based on pre-operative variable ORs, and complications between operative subgroups were compared. RESULTS: Independent predictors of CA in the derivation cohort were age ≥40 (OR 1.67; CI 1.55-1.80), male sex (OR 1.25; CI 1.17-1.34), black race (OR 1.46; CI 1.28-1.66), diabetes (OR 1.47; CI 1.31-1.65), obesity (OR 1.56; CI 1.40-1.74), and acute appendicitis with abscess or peritonitis (OR 7.00; CI 6.51-7.53). In the validation cohort, the CA predictive scoring model had an optimal cutoff score of 4 (range 0-9). The risk of conversion-to-open was ≤5% for a score <4, compared to 10-25% for a score ≥4. On composite outcomes analysis controlling for all pre-operative variables, CA had a higher likelihood of infectious/inflammatory (OR 1.44; CI 1.31-1.58), hematologic (OR 1.31; CI 1.17-1.46), and renal (OR 1.22; CI 1.06-1.39) complications compared to OA. Additionally, CA had a higher likelihood of infectious/inflammatory, respiratory, cardiovascular, hematologic, and renal complications compared to LA. CONCLUSIONS: CA patients have an unfavorable complication profile compared to OA. The predictors identified in this scoring model could help select for patients who may benefit from primary open appendectomy.
Authors: Sean J Donohue; Caroline E Reinke; Susan L Evans; Mary M Jordan; Yancey E Warren; Timothy Hetherington; Marc Kowalkowski; Addison K May; Brent D Matthews; Samuel W Ross Journal: Surg Endosc Date: 2021-09-03 Impact factor: 3.453
Authors: Maciej Walędziak; Anna Lasek; Michał Wysocki; Michael Su; Maciej Bobowicz; Piotr Myśliwiec; Kamil Astapczyk; Mateusz Burdzel; Karolina Chruściel; Rafał Cygan; Wojciech Czubek; Natalia Dowgiałło-Wnukiewicz; Jakub Droś; Paula Franczak; Wacław Hołówko; Artur Kacprzyk; Wojciech Konrad Karcz; Jakub Kenig; Paweł Konrad; Arkadiusz Kopiejć; Adam Kot; Karolina Krakowska; Maciej Kukla; Agnieszka Leszko; Leszek Łozowski; Piotr Major; Wojciech Makarewicz; Paulina Malinowska-Torbicz; Maciej Matyja; Maciej Michalik; Adam Niekurzak; Damian Nowiński; Radomir Ostaszewski; Małgorzata Pabis; Małgorzata Polańska-Płachta; Mateusz Rubinkiewicz; Tomasz Stefura; Anna Stępień; Paweł Szabat; Rafał Śmiechowski; Sebastian Tomaszewski; Viktor von Ehrlich-Treuenstätt; Maciej Wasilczuk; Mateusz Wierdak; Anna Wojdyła; Jan Wojciech Wroński; Leszek Zwolakiewicz; Michał Pędziwiatr Journal: Sci Rep Date: 2019-10-15 Impact factor: 4.379