Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Quebec, Canada; Department of Urology, European Institute of Oncology, IRCCS, Milan, Italy.
Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Quebec, Canada; Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy.
Surg Oncol. 2021 Mar;36:131-137. doi: 10.1016/j.suronc.2020.12.004. Epub 2020 Dec 11.
To test contemporary rates and predictors of open conversion at minimally invasive partial nephrectomy (MIPN: laparoscopic or robotic partial nephrectomy).
Within the National Inpatient Sample database (2008-2015) we identified all MIPN patients and patients that underwent open conversion at MIPN. First, estimated annual percentage changes (EAPC) tested temporal trends of open conversion. Second, univariable and multivariable logistic regression models predicted open conversion at MIPN. All models were weighted and adjusted for clustering, as well as all available patient and hospital characteristics.
Of 7649 MIPN patients, 287 (3.8%) underwent open conversion. The rates of open conversion decreased over time (from 12 to 2.4%; EAPC: 24.8%; p = 0.004). In multivariable logistic regression models predicting open conversion, patient obesity achieved independent predictor status (OR:1.80; p < 0.001). Moreover, compared to high volume hospitals, medium volume (OR:1.48; p = 0.02) and low volume hospitals (OR:2.11; p < 0.001) were associated with higher rates of open conversion. Last but not least, when the effect of obesity was tested according to hospital volume, the rates of open conversion ranged from 2.2 (non obese patients treated at high volume hospitals) to 9.8% (obese patients treated at low volume hospitals).
Overall contemporary (2008-2015) rate of open conversion at MIPN was 3.8% and it was strongly associated with patient obesity and hospital surgical volume. In consequence, these two parameters should be taken into account during preoperative patients counselling, as well as in clinical and administrative decision making.
检测微创部分肾切除术（MIPN：腹腔镜或机器人部分肾切除术）中转开放手术的当代发生率和预测因素。
在国家住院患者样本数据库（2008-2015 年）中，我们确定了所有 MIPN 患者和接受 MIPN 中转开放手术的患者。首先，估计年度百分比变化（EAPC）测试了中转开放手术的时间趋势。其次，单变量和多变量逻辑回归模型预测了 MIPN 中转开放手术的情况。所有模型均经过加权处理，并根据聚类以及所有可用的患者和医院特征进行了调整。
在 7649 例 MIPN 患者中，有 287 例（3.8%）接受了开放手术。中转开放手术的比例随时间呈下降趋势（从 12%降至 2.4%；EAPC：24.8%；p=0.004）。在预测 MIPN 中转开放手术的多变量逻辑回归模型中，患者肥胖成为独立预测因素（OR：1.80；p<0.001）。此外，与高容量医院相比，中容量（OR：1.48；p=0.02）和低容量医院（OR：2.11；p<0.001）与更高的中转开放手术率相关。最后但并非最不重要的是，当根据医院容量测试肥胖的影响时，中转开放手术的发生率从 2.2%（高容量医院治疗的非肥胖患者）到 9.8%（低容量医院治疗的肥胖患者）不等。
总体而言，当代（2008-2015 年）MIPN 中转开放手术的发生率为 3.8%，且与患者肥胖和医院手术量密切相关。因此，在术前患者咨询、临床和管理决策中应考虑这两个参数。
