Risk Factors and Outcomes for Conversion to Laparotomy of Laparoscopic Hysterectomy in Benign Gynecology
- 1 December 2016
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Obstetrics & Gynecology
- Vol. 128 (6), 1295-1305
- https://doi.org/10.1097/aog.0000000000001743
Abstract
To estimate the incidence and factors for conversion to laparotomy in women scheduled for laparoscopic hysterectomy for benign gynecologic indications and to examine the effect of conversion on patient outcomes. A retrospective cohort study of a Michigan multicenter prospective database was abstracted from January 1, 2013, through July 2, 2014. Participants were collected from an all-payer quality and safety database maintained by the Michigan Surgical Quality Collaborative. Women with a preoperative indication of cancer or obstetric indications were excluded. A logistic regression model was used to calculate odds of conversion using patient preoperative and intraoperative attributes. During the study period, 6,992 women underwent an attempted laparoscopic hysterectomy with 3.93% (n=275) converted to laparotomy. After adjusting for socioeconomic differences, hysterectomy indication, and intraoperative factors, there were decreased odds of conversion to laparotomy with use of robotic-assisted laparoscopy compared with traditional laparoscopy (adjusted odds ratio [OR] 0.14, 95% confidence interval [CI] 0.07–0.25) with a predicted risk of conversion of 0.8% compared with 5.4% (P<.001). High-volume surgeons were less likely to convert to laparotomy compared with low- and medium-volume surgeons (adjusted OR 0.66, 95% CI 0.47–0.92) with a predicted risk of conversion of 1.4% compared with 2.25% (P=.015). Conversion was associated with moderate or severe adhesive disease and increasing specimen weight. Conversion was associated with increased rates of surgical site infection, blood transfusion, severe sepsis, and reoperation. This analysis demonstrates that conversion to laparotomy is associated with increased odds of postoperative morbidity, and robotic assistance and surgeon volume are strongly associated with decreased odds of conversion.Keywords
This publication has 19 references indexed in Scilit:
- Clinical Relevance of Conversion Rate and its Evaluation in Laparoscopic HysterectomyJournal of Minimally Invasive Gynecology, 2013
- Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock, 2012Intensive Care Medicine, 2013
- Effect of Surgical Volume on Outcomes for Laparoscopic Hysterectomy for Benign IndicationsObstetrics & Gynecology, 2012
- Factors associated with complications and conversion to laparotomy in women undergoing laparoscopically assisted vaginal hysterectomyActa Obstetricia et Gynecologica Scandinavica, 2012
- Effect of Surgical Volume on Morbidity and Mortality of Abdominal Hysterectomy for Endometrial CancerObstetrics & Gynecology, 2011
- Factors Determining Conversion to Laparotomy in Patients Undergoing Total Laparoscopic HysterectomyGynecologic and Obstetric Investigation, 2010
- The Effect of Surgeon Volume on Outcomes and Resource Use for Vaginal HysterectomyObstetrics & Gynecology, 2010
- ACOG Committee Opinion No. 444: Choosing the Route of Hysterectomy for Benign DiseaseObstetrics & Gynecology, 2009
- CDC/NHSN surveillance definition of health care–associated infection and criteria for specific types of infections in the acute care settingAmerican Journal of Infection Control, 2008
- Total laparoscopic hysterectomy: Preoperative risk factors for conversion to laparotomyJournal of Minimally Invasive Gynecology, 2005