Laparoscopic converted to open colectomy: predictors and outcomes from the Nationwide Inpatient Sample

• Published in: The American journal of surgery 2011-05, Vol.201 (5), p.634-639
• Main Authors: Lu, Kim C., M.D, Cone, Molly M., M.D, Diggs, Brian S., Ph.D, Rea, Jennifer D., M.D, Herzig, Daniel O., M.D
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Benign; Biological and medical sciences; Clinical trials; Colectomy - methods; Colon; Colonic Diseases - surgery; Colorectal cancer; Colorectal surgery; Confidence intervals; Constipation; Conversion; Data analysis; Digestive system. Abdomen; Endoscopy; Female; Follow-Up Studies; General aspects; Hospitals; Humans; Inflammatory bowel disease; Inflammatory bowel diseases; Inpatients; Intestine; Investigative techniques, diagnostic techniques (general aspects); Laparoscopic colectomy; Laparoscopy; Laparoscopy - methods; Laparotomy - methods; Length of Stay; Male; Medical personnel; Medical sciences; Metastases; Metastasis; Morbidity; Mortality; Multivariate analysis; Nationwide Inpatient Sample; Outcomes; Patients; Polyps; Predictors; Registries - statistics & numerical data; Retrospective Studies; Socioeconomics; Stomach, duodenum, intestine, rectum, anus; Studies; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Treatment Outcome; United States; Variables
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/j.amjsurg.2011.01.009

Abstract Background Early in their learning curve, surgeons need to appropriately select patients to avoid conversion from laparoscopic to an open colectomy. Methods Using the Nationwide Inpatient Sample, laparoscopic and laparoscopic converted to open colectomies performed between 2002 and 2007 were compared. We evaluated patient and institutional characteristics to find significant predictors and outcomes of conversion. Results Between 2002 and 2007, the rate of conversion was high, ranging from 35.7% to 38.0%. Multivariate predictors of conversion included obesity, diverticulitis, inflammatory bowel disease, constipation, metastatic disease, nonelective admission, left or transverse colectomy, intraoperative complication, lower socioeconomic status, uninsured status, and rural hospital location. A colectomy for benign colon polyps was less likely to be converted. Conversion to an open colectomy did not increase inpatient mortality. Conclusions Predictors of conversion from open to laparoscopic colectomy were found from a national database reflecting all US laparoscopic colectomies. Conversion did not increase inpatient mortality.