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Feasibility of laparoscopy and factors associated with conversion to open in minimally invasive emergency major abdominal surgery: population database analysis

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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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Author information

Author notes

  1. Philip H. Pucher and Saqib A. Rahman have contributed equally to this study and are joint first authors.

Authors and Affiliations

  1. Department of General Surgery, Queen Alexandra Hospital, University Hospital Portsmouth NHS Trust, Portsmouth, UK

    Philip H. Pucher & Stuart J. Mercer

  2. Department of General Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK

    Saqib A. Rahman

  3. Department of General Surgery, University Hospital Plymouth NHS Trust, Plymouth, UK

    Hugh Mackenzie

  4. Department of Anaesthetics, Queen Alexandra Hospital, University Hospital Portsmouth NHS Trust, Portsmouth, UK

    Vanessa Tucker

Authors
  1. Philip H. Pucher
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  2. Saqib A. Rahman
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  3. Hugh Mackenzie
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  4. Vanessa Tucker
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  5. Stuart J. Mercer
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Contributions

PHP, SAR, SJM: study concept, data analysis, drafting of manuscript, final review. VT, HM: data analysis, study concept, final review.

Corresponding author

Correspondence to Philip H. Pucher.

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Disclosures

Dr. Philip Pucher receives consulting fees from Fundamental Surgery and declares no conflicts of interest. Dr. Saqib Rahman, Dr. Hugh Mackenzie, Dr. Vanessa Tucker, and Dr. Stuart Mercer declare no financial ties or conflicts of interest.

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Pucher, P.H., Rahman, S.A., Mackenzie, H. et al. Feasibility of laparoscopy and factors associated with conversion to open in minimally invasive emergency major abdominal surgery: population database analysis. Surg Endosc 36, 4499–4506 (2022). https://doi.org/10.1007/s00464-021-08803-5

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  • DOI: https://doi.org/10.1007/s00464-021-08803-5

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