Faculty Collaboration Database

Minimally invasive hepatectomy conversions: an analysis of risk factors and outcomes. HPB (Oxford) 2018 Feb;20(2):132-139

Date

12/01/2017

Pubmed ID

29183702

DOI

10.1016/j.hpb.2017.06.006

Scopus ID

2-s2.0-85034837878 (requires institutional sign-in at Scopus site)   21 Citations

Abstract

BACKGROUND: Surgical approach may influence morbidity following hepatectomy. This study sought to compare outcomes in minimally invasive surgery (MIS), conversion from MIS to open, and planned open hepatectomy patients and analyze factors leading to conversion.

METHODS: The 2014 National Surgical Quality Improvement Program dataset was queried for patients undergoing hepatectomy. Patients were divided into three cohorts: MIS, open, or conversion. Propensity matching was performed to compare MIS vs. conversion (3:1) and open vs. conversion (8:1). The logistic regression model was used to identify odds ratios for conversion.

RESULTS: Patients undergoing conversion had a higher transfusion rate (26% vs. 9%, p < 0.001), longer length of stay (5 vs. 3 days, p < 0.001), and higher morbidity (38% vs. 18%, p < 0.001) than MIS patients. Patients who underwent conversion had similar short-term outcomes to those who had planned open procedures. Independent predictors of conversion included hypertension (OR 1.91; 95% CI 1.12-3.26) and right lobectomy (OR 20.23; 95% CI 3.74-109.35).

CONCLUSION: Patients with hypertension and those undergoing right lobectomy had a higher risk of conversion to open procedure. Conversion resulted in higher morbidity and longer length of stay compared to MIS patients, but outcomes were similar to planned open procedures.

Author List

Silva JP, Berger NG, Yin Z, Liu Y, Tsai S, Christians KK, Clarke CN, Mogal H, Clark Gamblin T

Authors

Kathleen K. Christians MD Professor in the Surgery department at Medical College of Wisconsin
Callisia N. Clarke MD Chief, Associate Professor in the Surgery department at Medical College of Wisconsin
Thomas Clark Gamblin MD Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Aged
Blood Transfusion
Conversion to Open Surgery
Databases, Factual
Female
Hepatectomy
Humans
Hypertension
Laparoscopy
Length of Stay
Male
Middle Aged
Postoperative Complications
Retrospective Studies
Risk Assessment
Risk Factors
Time Factors
Treatment Outcome
United States