Gorgun E, Benlice C, Abbas M A, Stocchi L, Remzi F H
Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Ave. A-30, Cleveland, OH, 44195, USA.
Tech Coloproctol. 2016 Dec;20(12):845-851. doi: 10.1007/s10151-016-1554-z. Epub 2016 Dec 5.
The aim of the present study was to compare the perioperative outcomes in patients who underwent planned open colectomy to those who were converted to an open.
All patients who underwent elective colectomy were identified from the American College of Surgeons National Surgical Quality Improvement Program using procedure-targeted database (2012-2014). Patients were divided into two groups: open (planned) versus converted. Perioperative outcomes were compared. A logistic regression model was used to calculate the propensity of unplanned conversion as opposed to open surgery.
There were 21,437 patients; 17,366 (81.0%) in the open group and 4071 (19.0%) in the converted group. Operative time was longer in the converted group (212 ± 99 vs. 182 ± 111 min, p < 0.001), and hospital stay was longer in the open group (10.5 ± 9.3 vs. 8.7 ± 7.7 days, p < 0.001). Difference in morbidity rate (37.6% open vs. 34.5% converted, p < 0.001) was no longer significant once confounders were adjusted. Specific complications were similar except for superficial surgical site infection (SSI) rate, which was significantly lower in open group (odds ratio 0.87, 95% confidence interval 0.76-0.97, p = 0.010).
The current study showed that conversion of laparoscopic colectomy to an open approach was associated with slight increase in superficial SSI rate but shorter hospital stay compared to planned open.
本研究的目的是比较接受计划性开腹结肠切除术的患者与中转开腹患者的围手术期结局。
使用程序靶向数据库（2012 - 2014年）从美国外科医师学会国家外科质量改进计划中识别出所有接受择期结肠切除术的患者。患者分为两组：开腹（计划性）组与中转组。比较围手术期结局。使用逻辑回归模型计算与开腹手术相比非计划性中转的倾向。
共有21437例患者；开腹组17366例（81.0%），中转组4071例（19.0%）。中转组手术时间更长（212 ± 99 vs. 182 ± 111分钟，p < 0.001），开腹组住院时间更长（10.5 ± 9.3 vs. 8.7 ± 7.7天，p < 0.001）。调整混杂因素后，发病率差异（开腹组37.6% vs. 中转组34.5%，p < 0.001）不再显著。除浅表手术部位感染（SSI）率外，特定并发症相似，开腹组浅表手术部位感染率显著更低（比值比0.87，95%置信区间0.76 - 0.97，p = 0.010）。
当前研究表明，与计划性开腹相比，腹腔镜结肠切除术中转开腹与浅表SSI率略有增加但住院时间缩短有关。
