Pre operative C-Reactive Protein / Albumin Ratio as a predictor of conversion to open among patients undergoing laparoscopic appendicectomy: A single center Cross Sectional Study

Background Patients that underwent conversion to open appendicectomy tend to suffer a worse outcome when compared to patients that underwent full laparoscopic appendicectomy, or even those that underwent primary open appendicectomy. However, there is little information among available literatures on pre operative risk factors that can predict conversion to open appendicectomy. We aim to identify whether CRP/albumin ratio can be used as an independent predictor of conversion, thus becoming a useful adjunct in the clinical decision and approach to a patient with acute or perforated appendicitis. Methods A cross-sectional retrospective study was done in the National University of Malaysia Medical Centre. Patients that are listed for laparoscopic appendicectomy between June 2023 to December 2024 were recruited and are divided based on the eventual surgery performed: full laparoscopic appendicectomy vs conversion appendicectomy. The pre operative infective markers of these patients are recorded, alongside other secondary endpoints measured, including length of surgery and rates of post operative complications. Statistical analysis was performed using SPSS version 26. Results In this study, the CRP / albumin ratio, CRP and albumin are all statistically significantly different across both arms (P < 0.05). ROC and AUC analysis revealed that among the included infective markers, CRP/albumin ratio is the most powerful predictor of conversion to open appendicectomy, even after taking potential confounding factors into account using multivariate analysis. Patients with a CRP/albumin ratio of 0.111 and above have 24 times higher odds of requiring conversion to open appendicectomy. Conclusion This study concluded that CRP/albumin ratio is a robust independent predictor of conversion to open appendicectomy, and can be useful for pre operative assessment and surgical planning for patients suffering from acute appendicitis Clinical Trial Number Clinical trial number is not applicable as our research is a cross-sectional retrospective study.