The role of preoperative C-reactive protein value and neutrophil ratio in determination of conversion from laparoscopic appendectomy to open appendectomy

BACKGROUND:In this study, we aimed to investigate the factors causing conversion from laparoscopic appendectomy (LA) to open appendectomy (OA) in patients with acute appendicitis and to investigate the role of preoperative C reactive protein (CRP) and neutrophil ratio in this conversion and determine a cut-off point for these parameters.METHODS: Records of patients who underwent LA due to acute appendicitis at our general surgery department between January 2011 and January 2017 were retrospectively evaluated.The preoperative American Society of Anesthesiology (ASA) scores, Alvarado scores, white blood cell count, C-reactive protein level, and neutrophil ratio were evaluated.RESULTS: LA was performed in 394 patients with an initial diagnosis of acute appendicitis.A conversion to OA (cOA) was performed in 17 patients (4.31%).A CRP value of ≥108.5 mg/L and a neutrophil ratio of ≥81.5% were found to be statistically significant for the cOA (p<0.001). CONCLUSION:Our study results showed that male gender, age, elevated neutrophil ratio, and CRP value were the main risk factors for cOA in patients who were scheduled for LA due to acute appendicitis. Keywords: C-reactive protein; conversion to open surgery; laparoscopic appendectomy; neutrophil.of all appendectomies are now being performed through laparoscopy.[4] However, there is still no consensus with regard to which technique is superior.Several factors influence the conversion from LA to OA, including advanced age, male gender, obesity, intra abdominal abscess or perforation, and adhesions due to a previous abdominal surgery.[5] The conversion from the laparoscopic technique to the open technique leads to morbidities, such as prolongation of the operation time, increased cost, additional incision, prolonged duration of hospital stay, and postoperative wound infection.Therefore, many studies have been performed during the preoperative assessment to determine the most suitable technique for an individual patient.