Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
J Urol. 2014 Dec;192(6):1657-62. doi: 10.1016/j.juro.2014.06.029. Epub 2014 Jun 14.
Despite the increased use of minimally invasive radical prostatectomy, open conversion may occur due to surgical complications, surgeon inexperience or failure to progress. We used nationally representative data to quantify the impact of open conversion compared to nonconverted minimally invasive radical prostatectomy and open radical prostatectomy, and identify predictors of open conversion.
Years 2004 to 2010 of the Nationwide Inpatient Sample were queried for patients who underwent radical prostatectomy to analyze the association of open conversion during minimally invasive radical prostatectomy with Clavien complications. Multivariate regression models yielded significant predictors of open conversion.
From 2004 to 2010, 134,398 (95% CI 111,509-157,287) minimally invasive radical prostatectomies were performed with a 1.8% (95% CI 1.4-2.1) open conversion rate, translating to 2,360 (95% CI 2,001-2,720) conversions. Open conversion cases had a longer length of stay (4.17 vs 1.71 days, p <0.001) and higher hospital charges ($51,049 vs $37,418, p <0.001) than nonconverted cases. Of open conversion cases 45.2% experienced a complication vs 7.2% and 12.9% of minimally invasive radical prostatectomy and open radical prostatectomy cases, respectively (p <0.001). After adjusting for age and comorbidities, open conversion was associated with significantly increased odds of a Clavien grade 1, 2, 3 and 4 complication compared to nonconverted minimally invasive radical prostatectomy and open radical prostatectomy (OR range 2.913 to 15.670, p <0.001). Significant multivariate predictors of open conversion were obesity (OR 1.916), adhesions (OR 3.060), anemia (OR 5.692) and surgeon volume for minimally invasive radical prostatectomy less than 25 cases per year (OR 7.376) (all p <0.01).
Open conversion during minimally invasive radical prostatectomy is associated with a higher than expected increase in complications compared to open radical prostatectomy and minimally invasive radical prostatectomy after adjusting for age and comorbidities. External validation of predictors of open conversion may prove useful in minimizing open conversion during minimally invasive radical prostatectomy.
尽管微创根治性前列腺切除术的应用日益增多，但由于手术并发症、术者经验不足或手术进展失败，仍可能需要转为开放手术。我们使用全国代表性数据来量化与未转换的微创根治性前列腺切除术和开放性根治性前列腺切除术相比，开放转换的影响，并确定开放转换的预测因素。
在全国住院患者样本（2004 年至 2010 年）中检索接受根治性前列腺切除术的患者，分析微创根治性前列腺切除术中转为开放性手术与 Clavien 并发症的关系。多变量回归模型得出了与开放转换显著相关的预测因素。
2004 年至 2010 年间，进行了 134398 例（95%CI 111509-157287）微创根治性前列腺切除术，其中 1.8%（95%CI 1.4-2.1）的患者转为开放性手术，即 2360 例（95%CI 2001-2720）。与未转换的病例相比，开放转换病例的住院时间更长（4.17 天 vs. 1.71 天，p <0.001），住院费用更高（51049 美元 vs. 37418 美元，p <0.001）。在开放转换病例中，45.2%的患者发生并发症，而微创根治性前列腺切除术和开放性根治性前列腺切除术病例分别为 7.2%和 12.9%（p <0.001）。在调整年龄和合并症后，与未转换的微创根治性前列腺切除术和开放性根治性前列腺切除术相比，开放转换与 Clavien 1、2、3 和 4 级并发症的发生几率显著增加相关（OR 范围 2.913 至 15.670，p <0.001）。开放转换的显著多变量预测因素包括肥胖（OR 1.916）、粘连（OR 3.060）、贫血（OR 5.692）和每年微创根治性前列腺切除术病例数少于 25 例的术者（OR 7.376）（均 p <0.01）。
在调整年龄和合并症后，与开放性根治性前列腺切除术和微创根治性前列腺切除术相比，微创根治性前列腺切除术中的开放转换与并发症发生率的显著增加相关。对开放转换预测因素的外部验证可能有助于最大限度地减少微创根治性前列腺切除术的开放转换。
