Bhama A R, Charlton M E, Schmitt M B, Cromwell J W, Byrn J C
Department of Surgery, Division of Gastrointestinal, Minimally Invasive and Bariatric Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.
Colorectal Dis. 2015 Mar;17(3):257-64. doi: 10.1111/codi.12800.
Conversion rates from laparoscopic to open colectomy and associated factors are traditionally reported in clinical trials or reviews of outcomes from experienced institutions. Indications and selection criteria for laparoscopic colectomy may be more narrowly defined in these circumstances. With the increased adoption of laparoscopy, conversion rates using national data need to be closely examined. The purpose of this study was to use data from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) to identify factors associated with conversion of laparoscopic to open colectomy at a national scale in the United States.
The ACS-NSQIP Participant Use Data Files for 2006-2011 were used to identify patients who had undergone laparoscopic colectomy. Converted cases were identified using open colectomy as the primary procedure and laparoscopic colectomy as 'other procedure'. Preoperative variables were identified and statistics were calculated using sas version 9.3. Logistic regression was used to model the multivariate relationship between patient variables and conversion status.
Laparoscopy was successfully performed in 41 585 patients, of whom 2508 (5.8%) required conversion to an open procedure. On univariate analysis the following factors were significant: age, body mass index (BMI), American Society of Anesthesiologists (ASA) class, presence of diabetes, smoking, chronic obstructive pulmonary disease, ascites, stroke, weight loss and chemotherapy (P < 0.05). The following factors remained significant on multivariate analysis: age, BMI, ASA class, smoking, ascites and weight loss.
Multiple significant factors for conversion from laparoscopic to open colectomy were identified. A novel finding was the increased risk of conversion for underweight patients. As laparoscopic colectomy is become increasingly utilized, factors predictive of conversion to open procedures should be sought via large national cohorts.
传统上，腹腔镜结肠切除术转为开腹结肠切除术的转化率及相关因素是在临床试验或对经验丰富机构的结果回顾中报告的。在这些情况下，腹腔镜结肠切除术的适应证和选择标准可能定义得更为狭窄。随着腹腔镜技术应用的增加，需要仔细研究基于全国数据的转化率。本研究的目的是利用美国外科医师学会国家外科质量改进计划（ACS-NSQIP）的数据，在美国全国范围内确定与腹腔镜结肠切除术转为开腹结肠切除术相关的因素。
使用2006 - 2011年的ACS-NSQIP参与者使用数据文件来识别接受过腹腔镜结肠切除术的患者。将以开腹结肠切除术作为主要手术且腹腔镜结肠切除术作为“其他手术”的病例确定为转换病例。确定术前变量并使用SAS 9.3版计算统计数据。采用逻辑回归对患者变量与转换状态之间的多变量关系进行建模。
41585例患者成功实施了腹腔镜手术，其中2508例（5.8%）需要转为开腹手术。单因素分析显示，以下因素具有统计学意义：年龄、体重指数（BMI）、美国麻醉医师协会（ASA）分级、糖尿病、吸烟、慢性阻塞性肺疾病、腹水、中风、体重减轻和化疗（P < 0.05）。多因素分析显示，以下因素仍具有统计学意义：年龄、BMI、ASA分级、吸烟、腹水和体重减轻。
确定了多个与腹腔镜结肠切除术转为开腹结肠切除术相关的重要因素。一个新发现是体重过轻患者转换的风险增加。随着腹腔镜结肠切除术的应用越来越广泛，应通过大型全国队列研究寻找预测转为开腹手术的因素。
