title: Laparoscopic appendectomy conversion rates two decades later: an analysis of surgeon and patient-specific factors resulting in open conversion.
abstract: 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.
  
  
  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.
authors.affiliation: Department of Surgery, Saint Barnabas Medical Center, Livingston, New Jersey 07039, USA.
authors.forename: Sujit Vijay
authors.initials: SV
authors.lastname: Sakpal
authors.forename: Supreet S
authors.initials: SS
authors.lastname: Bindra
authors.forename: Ronald S
authors.initials: RS
authors.lastname: Chamberlain
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D001062:Appendectomy / Q000379:methods / Q000706:statistics & numerical data / Q000639:trends*; D001064:Appendicitis / Q000601:surgery*; D002983:Clinical Competence; D005260:Female; D006764:Hospitals, Community; D006801:Humans; D015994:Incidence; D007249:Inflammation / Q000453:epidemiology*; D010535:Laparoscopy / Q000379:methods / Q000706:statistics & numerical data / Q000639:trends*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012737:Sex Factors; D000267:Tissue Adhesions / Q000453:epidemiology*