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World Journal of Surgery

, Volume 39, Issue 5, pp 1240–1247 | Cite as

Risk Factors for Conversion of Laparoscopic Colorectal Surgery to Open Surgery: Does Conversion Worsen Outcome?

  • Hossein Masoomi
  • Zhobin Moghadamyeghaneh
  • Steven Mills
  • Joseph C. Carmichael
  • Alessio Pigazzi
  • Michael J. StamosEmail author
Original Scientific Report

Abstract

Introduction

The utilization of laparoscopy in colorectal surgery is increasing. However, conversion to open surgery remains relatively high.

Objective

We evaluated (1) conversion rates in laparoscopic colorectal surgery; (2) the outcomes of converted cases compared with successful laparoscopic and open colorectal operations; (3) predictive risk factors of conversion of laparoscopic colorectal surgery to open surgery.

Methods

Using the National Inpatient Sample database, we examined the clinical data of patients who underwent colon and rectal resection from 2009 to 2010. Multivariate regression analysis was performed to identify factors predictive for conversion of laparoscopic to open operation.

Results

A total of 207,311 patients underwent intended laparoscopic colorectal resection during this period. The conversion rate was 16.6 %. Considering resection type and pathology, the highest conversion rates were observed in proctectomy (31.4 %) and Crohn’s disease (20.2 %). Using multivariate regression analysis, Crohn’s disease (adjusted odds ratio [AOR], 2.80), prior abdominal surgery (AOR, 2.45), proctectomy (AOR, 2.42), malignant pathology (AOR, 1.90), emergent surgery (AOR, 1.82), obesity (AOR, 1.63), and ulcerative colitis (AOR, 1.60) significantly impacted the risk of conversion. Compared with patients who were successfully completed laparoscopically, converted patients had a significantly higher complication rate (laparoscopic: 23 %; vs. converted: 35.2 % vs. open: 35.3 %), a higher in-hospital mortality rate (laparoscopic: 0.5 %; vs. converted: 0.6 %; vs. open: 1.7 %) and a longer mean hospital stay (laparoscopic: 5.4 days; vs. converted: 8.1 days; vs. open: 8.4 days); however, converted patients had better outcomes compared with the open group.

Conclusions

The conversion rate in colorectal surgery was 16.6 %. Converted patients had significantly higher rates of morbidity and mortality compared to successfully completed laparoscopic cases, although lower than open cases. Crohn’s disease, prior abdominal surgery, and proctectomy are the strongest predictors for conversion of laparoscopic to open in colorectal operations.

Keywords

Diverticulitis Colorectal Resection Rectal Resection Nationwide Inpatient Sample High Conversion Rate 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Copyright information

© Société Internationale de Chirurgie 2015

Authors and Affiliations

  • Hossein Masoomi
    • 1
  • Zhobin Moghadamyeghaneh
    • 1
  • Steven Mills
    • 1
  • Joseph C. Carmichael
    • 1
  • Alessio Pigazzi
    • 1
  • Michael J. Stamos
    • 1
    • 2
    Email author
  1. 1.Department of SurgeryUniversity of California, Irvine School of MedicineIrvineCalifornia
  2. 2.Department of SurgeryOrangeUSA

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