Factors associated with conversion from laparoscopic to open colectomy using the National Surgical Quality Improvement Program (NSQIP) database

A R Bhama; M E Charlton; M B Schmitt; J W Cromwell; J C Byrn

doi:10.1111/codi.12800

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Journal article

Factors associated with conversion from laparoscopic to open colectomy using the National Surgical Quality Improvement Program (NSQIP) database

A R Bhama, M E Charlton, M B Schmitt, J W Cromwell and J C Byrn

Colorectal disease, Vol.17(3), pp.257-264

03/2015

DOI: 10.1111/codi.12800

PMCID: PMC4329054

PMID: 25311007

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http://doi.org/10.1111/codi.12800View

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Abstract

Conversion rates from laparoscopic to open colectomy and associated factors are traditionally reported in clinical trials or reviews of outcomes from experienced institutions. Indications and selection criteria for laparoscopic colectomy may be more narrowly defined in these circumstances. With the increased adoption of laparoscopy, conversion rates using national data need to be closely examined. The purpose of this study was to use data from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) to identify factors associated with conversion of laparoscopic to open colectomy at a national scale in the United States. The ACS-NSQIP Participant Use Data Files for 2006-2011 were used to identify patients who had undergone laparoscopic colectomy. Converted cases were identified using open colectomy as the primary procedure and laparoscopic colectomy as 'other procedure'. Preoperative variables were identified and statistics were calculated using sas version 9.3. Logistic regression was used to model the multivariate relationship between patient variables and conversion status. Laparoscopy was successfully performed in 41 585 patients, of whom 2508 (5.8%) required conversion to an open procedure. On univariate analysis the following factors were significant: age, body mass index (BMI), American Society of Anesthesiologists (ASA) class, presence of diabetes, smoking, chronic obstructive pulmonary disease, ascites, stroke, weight loss and chemotherapy (P < 0.05). The following factors remained significant on multivariate analysis: age, BMI, ASA class, smoking, ascites and weight loss. Multiple significant factors for conversion from laparoscopic to open colectomy were identified. A novel finding was the increased risk of conversion for underweight patients. As laparoscopic colectomy is become increasingly utilized, factors predictive of conversion to open procedures should be sought via large national cohorts.

Multivariate Analysis

Body Weight

Quality Improvement - statistics & numerical data

Age Factors

United States

Humans

Middle Aged

Colectomy - methods

Colorectal Surgery - statistics & numerical data

Male

Anesthesia - classification

Colorectal Surgery - standards

Aged, 80 and over

Adult

Female

Body Mass Index

Risk Factors

Databases, Factual - statistics & numerical data

Quality Improvement - standards

Logistic Models

Laparoscopy - statistics & numerical data

Conversion to Open Surgery - statistics & numerical data

Smoking - epidemiology

Ascites - epidemiology

Aged

Details

Title: Subtitle: Factors associated with conversion from laparoscopic to open colectomy using the National Surgical Quality Improvement Program (NSQIP) database
Creators: A R Bhama - Department of Surgery, Division of Gastrointestinal, Minimally Invasive and Bariatric Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
M E Charlton
M B Schmitt
J W Cromwell
J C Byrn
Resource Type: Journal article
Publication Details: Colorectal disease, Vol.17(3), pp.257-264
DOI: 10.1111/codi.12800
PMID: 25311007
PMCID: PMC4329054
NLM abbreviation: Colorectal Dis
ISSN: 1463-1318
eISSN: 1463-1318
Publisher: England
Grant note: P30 CA086862 / NCI NIH HHS
Language: English
Date published: 03/2015
Academic Unit: Health Management and Policy; Epidemiology; Surgery
Record Identifier: 9983996199302771

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