Elizabeth R Raskin, MD1, Dongjing Guo2, Shilpa Mehendale, MD2. 1Loma Linda University, 2ISI
Introduction: Providing predictable outcomes after minimally invasive surgery (MIS) is an important priority for patients, hospitals and policy makers. The aim of this study was to examine the patterns and markers associated with conversion of MIS to open procedures in high volume hospitals and to understand the specific risk factors associated with high and lower conversion rates hospitals.
Methods and Procedures: Using the Premier health care database, we selected data from institutions who performed at least 100 laparoscopic-assisted (LA) or robotic-assisted (RA) sigmoidectomy cases during 2013 and 2015Q3. Data from non-elective cases or patients < 18 years old were excluded. The median hospital level conversion rate was selected as the cutoff to categorize hospitals as “higher-conversion rate” or “lower-conversion rate” hospitals. Data from patients treated at the above categorized hospitals were compared. A step-wise backward model selection method was applied to identify the risk factors associated with conversion using logistic regression model for both cohorts. Unadjusted conversion rates and adjusted odds ratios for the different surgical approaches were reported.
Results: Data for 8821 patients from 75 hospitals were analyzed. The median conversion rate was 10.85%. Hospitals with bed size <300 were more likely to have lower conversion rates.
Among patients from higher-conversion rate hospitals, the conversion rate for LA and RA approaches were 18.41% (95%CI: 17.15-19.67%) and 11.33% (95%CI: 9.02-13.99%), respectively (Figure A); After adjusting for patients’ age, Charleson score, race and insurance type in the multivariable logistic regression model, LA approach still had 75% (95%CI: 36-127%) higher risk for conversion than the RA approach (Figure B). Among patients from lower-conversion rate hospitals, the conversion rate for the LA and RA approach were 7.33% (95%CI: 6.49-8.16%) and 2.89% (95%CI: 1.70-4.09%), respectively (Figure A). After adjusting for patients’ age, Charleson score, and hospital bed size in the multivariable logistic regression model, patients underwent LA sigmoidectomy were 2.5 (95%CI: 1.6-4.0) times more likely to be converted to open than patients who underwent RA sigmoidectomy (Figure C).
Subset analyses of patients with malignancy and benign disease showed similar results.
Conclusions: In high-volume hospitals, the RA approach demonstrated significantly lower risk for conversion than the LA approach in both higher-conversion rate and lower-conversion rate hospitals. This study demonstrates reduced variability in conversion rates and consistency with the robotic-assisted approach compared to laparoscopy.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 94864
Program Number: P322
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster