Preoperative Risk Factors Associated with Conversion from Laparoscopic to Open Appendectomy

Open Access

Abstract

Background: Acute appendicitis is a common surgical emergency, and laparoscopic appendectomy is the preferred operative approach because of its favorable postoperative outcomes. However, conversion to open surgery may be required in patients with severe inflammation, complicated appendicitis, or technical difficulty, and may increase morbidity. Aim of the study: This study aimed to identify clinical, laboratory, and radiological preoperative risk factors associated with conversion from laparoscopic to open appendectomy. Methods & Materials: This hospital-based observational study was conducted at the Department of Surgery, Cox's Bazar Medical College, Cox's Bazar, Bangladesh, from January 2025 to December 2025 including 250 consecutive patients undergoing laparoscopic appendectomy for acute appendicitis. Demographic, clinical, laboratory, and imaging variables were recorded preoperatively. Conversion to open appendectomy was the primary outcome. Data were analyzed using SPSS version 27.0, with chi-square and independent-samples t-tests for group comparisons and multivariable logistic regression to identify independent predictors of conversion; p<0.05 was considered statistically significant. Results: Among 250 patients, the mean age was 31.8 ± 12.6 years, and 59.2% were male. Overall, 18 patients (7.2%) required conversion to open appendectomy. Compared with laparoscopically completed cases, converted patients more frequently had symptoms >48 hours, elevated WBC and CRP, suspected perforation, and complicated appendicitis. After adjustment, symptoms >48 hours (AOR 3.08), appendicular mass/phlegmon (AOR 4.15), suspected perforation (AOR 4.42), and complicated appendicitis on imaging (AOR 5.21) independently predicted conversion. Conclusion: Conversion to open appendectomy was uncommon but was strongly associated with delayed presentation and complicated appendicitis, particularly phlegmon and perforation. Careful preoperative risk stratification and timely surgical management may help anticipate conversion and improve operative planning.