Rocco Ricciardi1, Caitlin Stafford1, Todd Francone1, Peter Marcello2, Patricia L Roberts2. 1MGH, 2Lahey Hospital & Medical Center
Introduction: We studied the risk factors for laparoscopic (Lap) conversion across a group of subspecialist colorectal surgeons with expertise in minimally invasive techniques.
Methods: We reviewed our prospective database for Lap conversion cases among all consecutive abdominopelvic procedures performed from 7/1/2007 through 12/31/2016. First, we identified procedures that were converted from Lap to open. Next, we performed a case-controlled trial by matching Lap converted procedures to Lap completed procedures. Then we abstracted covariates such as reason for conversion, prior abdominal surgery, procedure type, patient diagnosis, BMI, incision time, use of a hand assist, and ASA score. Last we developed multivariate models to identify risk factors for Lap conversion to open surgery adjusting for all listed covariates.
Results: From a database of 12,454 procedures, we identified 100 Lap colorectal procedures converted to open surgery and matched them to 339 Lap completed procedures. In the entire dataset of abdominopelvic procedures, Lap techniques were attempted in 49+/-1%. Among surgeon’s with more than 50 Lap cases, we found significant variability in Lap attempts (range of 16% to 65% of any one surgeon’s cases) and substantial variability in surgeon specific conversion rates (range 1% to 8%; median of 7%). However, there was no correlation between surgeon Lap attempt rate and surgeon Lap conversion rate (p=0.4). There was also no correlation between surgery start time and Lap conversion. The most common reasons for conversion were adhesions (n=47) and difficult patient anatomy (n=35). Proportionately more patients with a diagnosis of inflammatory bowel disease (6%) were converted to open as compared to the diagnoses of neoplasm (3%) or diverticulitis (4%) (p < 0.05). Furthermore, proportionately more lap abdominoperineal resections (12.5%) were converted to open as compared to ileocolic resections (5.5%) or left colectomy (2.8%) (p<0.05). On multivariate analysis, both male sex and prior history of abdominopelvic surgery increased the risk of Lap conversion while the use of a hand assist technique attenuated conversion risk.
Conclusions: Our data reveal a low rate of Lap conversion to open surgery despite a high rate of Lap attempted colorectal surgery. Increased surgeon affinity for Lap attempted surgery did not influence Lap conversion rates but the surgical indication of inflammatory bowel disease and the procedure of abdominoperineal resection did elevate the risk of Lap conversion. On multivariate analysis, prior abdominal surgery was associated with increased risk of conversion and was the most common reason reported for conversion on the operative report.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87337
Program Number: P192
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster