TY - JOUR
T1 - Risk factors for conversion from laparoscopic to open surgery
T2 - Analysis of 2138 converted operations in the american college of surgeons national surgical quality improvement program
AU - Papandria, Dominic
AU - Lardaro, Thomas
AU - Rhee, Daniel
AU - Ortega, Gezzer
AU - Gorgy, Amany
AU - Makary, Martin A.
AU - Abdullah, Fizan
PY - 2013/9/1
Y1 - 2013/9/1
N2 - Minimal access procedures have influenced surgical practice and patient expectations. Risk of laparoscopic conversion to open surgery is frequently cited but vaguely quantified. The present study examines three common procedures to identify risk factors for laparoscopic conversion to open (LCO) events. Cross-sectional analysis using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP; 2005 to 2009) identified cases with laparoscopic procedure codes for appendectomy, cholecystectomy, and bariatric procedures. The primary outcome was conversion of a laparoscopic procedure to its open equivalent. Summary statistics for laparoscopic and LCO groups were compared and logistic regression analysis was used to estimate patient and operative risk factors for conversion. Of 176,014 selected laparoscopic operations, 2,138 (1.2%) were converted. Most patients were female (68%) and white (71.2%); mean age was 45.1 years. LCO cholecystectomy was significantly more likely (n 5 1526 [1.9%]) and LCO bariatric procedures were less likely (= 5 121 [0.3%]); appendectomy was intermediate (n 5 491 [1.0%], P<0.001). Patient factors associated with LCO included male sex (P <0.001), age 30 years or older (P<0.025), American Society of Anesthesiologists Class 2 to 4 (P<0.001), obesity (P< 0.01), history of bleeding disorder (P = 0.036), or preoperative systemic inflammatory response syndrome or sepsis (P < 0.001). LCO was associated with greater incidence of postoperative complications, including death, organ space surgical site infection, sepsis, wound dehiscence, and return to the operating room (P<0.001). Overall LCO incidence is low in hospitals participating in ACS-NSQIP. Conversion risk factors include patient age, sex, obesity, and preoperative comorbidity as well as the procedure performed. This information should be valuable to clinicians in discussing conversion risk with patients.
AB - Minimal access procedures have influenced surgical practice and patient expectations. Risk of laparoscopic conversion to open surgery is frequently cited but vaguely quantified. The present study examines three common procedures to identify risk factors for laparoscopic conversion to open (LCO) events. Cross-sectional analysis using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP; 2005 to 2009) identified cases with laparoscopic procedure codes for appendectomy, cholecystectomy, and bariatric procedures. The primary outcome was conversion of a laparoscopic procedure to its open equivalent. Summary statistics for laparoscopic and LCO groups were compared and logistic regression analysis was used to estimate patient and operative risk factors for conversion. Of 176,014 selected laparoscopic operations, 2,138 (1.2%) were converted. Most patients were female (68%) and white (71.2%); mean age was 45.1 years. LCO cholecystectomy was significantly more likely (n 5 1526 [1.9%]) and LCO bariatric procedures were less likely (= 5 121 [0.3%]); appendectomy was intermediate (n 5 491 [1.0%], P<0.001). Patient factors associated with LCO included male sex (P <0.001), age 30 years or older (P<0.025), American Society of Anesthesiologists Class 2 to 4 (P<0.001), obesity (P< 0.01), history of bleeding disorder (P = 0.036), or preoperative systemic inflammatory response syndrome or sepsis (P < 0.001). LCO was associated with greater incidence of postoperative complications, including death, organ space surgical site infection, sepsis, wound dehiscence, and return to the operating room (P<0.001). Overall LCO incidence is low in hospitals participating in ACS-NSQIP. Conversion risk factors include patient age, sex, obesity, and preoperative comorbidity as well as the procedure performed. This information should be valuable to clinicians in discussing conversion risk with patients.
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M3 - Article
C2 - 24069991
AN - SCOPUS:84883635888
SN - 0003-1348
VL - 79
SP - 914
EP - 921
JO - American Surgeon
JF - American Surgeon
IS - 9
ER -