Predictive role of selective laboratory parameters for the occurrence of “unwanted events” in the patient treated with laparoscopic appendectomy

The aim of our study is to measure the predictive role of certain laboratory
parameters in recognizing the cases in which laparoscopic appendectomy (LA)
would be associated with various kind of ‘‘unwanted events’’ such as: intraoperative
difficulties, complications or conversion to open approach. We conducted a
prospective, cohort, clinical study, between 2016 and 2018, in the Clinical hospital
of Shtip and in the University clinic for digestive surgery, in Skopje. Exactly 75 adult
patients with acute appendicitis (AA) and performed LA or conversion were
included in the study. A total of 25 laboratory parameters were measured preoper-
atively in each patient. Intraoperatively for each patients the intraoperative
difficulties were registered as well as any kind of intraoperative complication or the
reason for conversion if present. Postoperatively each patient was followed on the
7-th and 30-th postoperative day for the presence of abdominal or extra abdominal
complications. From the 75 (100%) participants in the study, 51(68%) were included
in the group ‘‘without unwanted events’’ and 24 (32%) were included in the group
‘‘with unwanted events’’. The analysis indicated that there was no significant dif-
ference between the groups regarding the gender and the age of the patients.
Regarding the 25 laboratory parameters the binary statistical analysis showed that
there is significantly higher values of total bilirubin, sodium and C—reactive protein
in the group ‘‘with unwanted events’’. Additionally, the multiple logistic regression
analysis showed that the value of the total serum bilirubin is the only independent
predictor for occurrence of ‘‘unwanted events’’ during LA. When deciding to utilize
the laparoscopic approach in the treatment of AA, a close attention should be paid on
the extremely high values of the CRP, high values of total serum bilirubin and high
values of serum sodium. In such cases one should consider the possibility to use the
open approach in the surgical treatment of AA or at least the laparoscopic explo-
ration should be done in the presence of an experienced surgeon.