Feasibility of laparoscopy and factors associated with conversion to open in minimally invasive emergency major abdominal surgery: population database analysis
- 01.11.2021
Erschienen in:
- Verfasst von
- Philip H. Pucher
- Saqib A. Rahman
- Hugh Mackenzie
- Vanessa Tucker
- Stuart J. Mercer
- Erschienen in
- Surgical Endoscopy | Ausgabe 6/2022
Abstract
Background
There is limited evidence regarding the overall feasibility and success rates of the laparoscopic approach in major emergency surgery, despite its potential to improve outcomes. This study aims to investigate the association between patient, procedural, and surgical factors and likelihood of successful laparoscopic completion in emergency major surgery and derive a predictive model to aid clinical decision-making.
Method
All patients recorded in the NELA emergency laparotomy database 1 December 2013–31 November 2018 who underwent laparoscopically attempted surgery were included. A retrospective cohort multivariable regression analysis was conducted for the outcome of conversion to open surgery. A predictive model was developed and internally validated.
Results
Of 118,355 patients, 17,040 (7.7%) underwent attempted laparoscopic surgery, of which 7.915 (46.4%) were converted to open surgery. Procedure type was the strongest predictor of conversion (compared to washout as reference, small bowel resection OR 25.93 (95% CI 20.42–32.94), right colectomy OR 6.92 (5.5–8.71)). Diagnostic [free pus, blood, or blood OR 3.67 (3.29–4.1)] and surgeon [subspecialist surgeon OR 0.56 (0.52–0.61)] factors were also significant, whereas age, gender, and pre-operative mortality risk were not. A derived predictive model had high internal validity, C-index 0.758 (95% CI 0.748–0.768), and is available for free-use online.
Conclusion
Surgical, patient, and diagnostic variables can be used to predict likelihood of laparoscopic success with a high degree of accuracy. This information can be used to inform peri-operative decision-making and patient selection.
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- Titel
- Feasibility of laparoscopy and factors associated with conversion to open in minimally invasive emergency major abdominal surgery: population database analysis
- Verfasst von
-
Philip H. Pucher
Saqib A. Rahman
Hugh Mackenzie
Vanessa Tucker
Stuart J. Mercer
- Publikationsdatum
- 01.11.2021
- Verlag
- Springer US
- Erschienen in
-
Surgical Endoscopy / Ausgabe 6/2022
Print ISSN: 0930-2794
Elektronische ISSN: 1432-2218 - DOI
- https://doi.org/10.1007/s00464-021-08803-5
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