Cigdem Benlice, MD1, Emre Gorgun, MD1, Maher A Abbas, MD2, Feza H Remzi, MD1. 1Cleveland Clinic, Digestive Disease Institute, Department of Colorectal Surgery, 2Digestive Disease Institute, Cleveland Clinic Abu Dhabi
Introduction: Conversion form laparoscopy to open surgery may have worse outcomes than successfully completed laparoscopic procedures. There is limited data comparing converted laparoscopic to open procedures. We aimed to investigate if conversion in a large cohort of colectomy procedures negatively impacts short-term outcomes compared to open approaches.
Methods: All patients who underwent elective colectomy in 2012 were identified from American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) using the new procedure-targeted database. Patients were then divided into two groups according to the final surgical approach: Open(planned) vs. Converted(planned laparoscopy, converted to open). Patient demographics, preoperative comorbidities, and 30-day outcomes were compared between the groups. Multivariable logistic regression analysis was conducted for further covariate adjustments.
Results: A total of 6277 patients included into study. There were 5249(83.6%) patients in Open colectomy and 1028(16.4%) in Converted colectomy group. Groups were comparable in terms of preoperative characteristics and demographics except gender (52.1% vs.46.8% for female, p=0.0017), body mass index (28.1vs.29.4 kg/m2, p<0.0001), ascites (1.8% vs.0.5%, p=0.0009), hypertension (49.7% vs. 55.8%, p=0.0003), disseminated cancer (11.2% vs.4.9%, p<0.0001), previous wound infection (3.7% vs.1.3%, p<0.0001), steroid use (8.4% vs. 10.4%, p=0.04), preoperative transfusion (3.7% vs.1.9%, p=0.0035), preoperative sepsis (7.5% vs. 4.4%, p=0.0002), and American Society of Anesthesiologists (ASA)(60.7% vs.50.8% for ASA III-IV scores, p<0.0001). Mean operative time was significantly longer in the Converted group (180 ±114.5 vs.207 ±93.8 minutes, p<0.0001). Table summarizes postoperative outcomes. Overall morbidity rate and bleeding requiring transfusion were higher in the Open group. Superficial surgical site infection rate was higher in the Converted group. After adjustment for the comorbid conditions using logistic regression, the degree of differences between the groups disappeared in terms of morbidity rate (p=0.28) and bleeding requiring transfusion (p=0.95), but superficial SSI rate was still higher in the Converted group (Odds ratio: 1.3, p=0.004).
Conclusion: Converted laparoscopic colectomy cases have similar outcomes compared to open approach from a nationwide targeted database.
|
Open (N=5249) |
Converted (N=1028) |
Pvalue | |
| Operative time,min | 180(114) | 206(93.8) | <0.001 |
| Length of hospital stay,day | 10.6(9.6) | 8.8(8.3) | <0.001 |
| Morbidity rate,(%) | 2067(39.4) | 364(35.4) | 0.01 |
| Superficial SSI | 475(9) | 127(12.3) | 0.001 |
| Deep SSI | 108(2.1) | 24(2.3) | 0.55 |
| Organ space SSI | 321(6.1) | 57(5.5) | 0.51 |
| Wound disruption | 91(1.7) | 25(2.4) | 0.12 |
| Bleeding requiring transfusion | 901(17.2) | 144(14) | 0.01 |
| Pulmonary emboli | 50 (0.9) | 11 (1) | 0.72 |
| DVT/thrombophlebitis | 103(2) | 19(1.8) | 0.90 |
| Sepsis | 31(5.9) | 48(4.7) | 0.12 |
| Urinary tract infection | 235(4.5) | 41(4) | 0.56 |
| Anastomotic leak | 243(4.6) | 37(3.6) | 0.15 |
| Prolonged ileus | 1084(20.7) | 208(20.4) | 0.80 |
| Readmission | 638(12.1) | 129(12.5) | 0.71 |