Predictors and implications of unplanned conversion during minimally invasive hepatectomy

an analysis of the ACS-NSQIP database

Zachary E. Stiles, Stephen W. Behrman, Evan Glazer, Jeremiah Deneve, Lei Dong, Jim Wan, Paxton V. Dickson

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Background Minimally-invasive hepatectomy (MIH) is increasingly utilized; however, predictors and outcomes for patients requiring conversion to an open procedure have not been adequately studied. Methods The 2014–15 ACS-NSQIP database was analyzed. Unplanned conversion was compared to successful MIH and elective open hepatectomy. Results Among 6918 hepatectomies, 1062 (15.4%) underwent attempted MIH: 989 laparoscopic, 73 robotic. Conversion occurred in 203 (19.1%). Compared to successful MIH, patients requiring unplanned conversion experienced higher rates of complications (34.5% vs 14.6%, p < 0.001), including bile leaks (7.4% vs 2.8%, p = 0.002), organ space infection (6.4% vs 2.9%, p = 0.016), UTI (4.9% vs 1.2%, p = 0.002), perioperative bleeding (21.2% vs 6.1%, p < 0.001), DVT (3.0% vs 0.8%, p = 0.024), and sepsis (5.9% vs 1.9%, p = 0.001). Conversion led to greater LOS (5 days vs 3 days, p < 0.001) and 30-day mortality (3.0% vs 0.5%, p = 0.005). Compared to elective open hepatectomy, conversion was associated with greater perioperative bleeding (21.2% vs 15.3%, p = 0.037). On multivariate analysis, major hepatectomy (OR 2.21, p < 0.001), concurrent ablation (OR 1.79, p = 0.020), and laparoscopic approach (vs. robotic) (OR 3.22, p = 0.014) were associated with conversion. Conclusion Analysis of this national database revealed unplanned conversion during MIH is associated with greater morbidity and mortality. MIH should be approached cautiously in patients requiring major hepatectomy.

Original languageEnglish (US)
Pages (from-to)957-965
Number of pages9
JournalHPB
Volume19
Issue number11
DOIs
StatePublished - Nov 1 2017

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Hepatectomy
Databases
Robotics
Hemorrhage
Conversion to Open Surgery
Mortality
Bile
Sepsis
Multivariate Analysis
Morbidity

All Science Journal Classification (ASJC) codes

  • Hepatology
  • Gastroenterology

Cite this

Predictors and implications of unplanned conversion during minimally invasive hepatectomy : an analysis of the ACS-NSQIP database. / Stiles, Zachary E.; Behrman, Stephen W.; Glazer, Evan; Deneve, Jeremiah; Dong, Lei; Wan, Jim; Dickson, Paxton V.

In: HPB, Vol. 19, No. 11, 01.11.2017, p. 957-965.

Research output: Contribution to journalArticle

Stiles, Zachary E. ; Behrman, Stephen W. ; Glazer, Evan ; Deneve, Jeremiah ; Dong, Lei ; Wan, Jim ; Dickson, Paxton V. / Predictors and implications of unplanned conversion during minimally invasive hepatectomy : an analysis of the ACS-NSQIP database. In: HPB. 2017 ; Vol. 19, No. 11. pp. 957-965.
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abstract = "Background Minimally-invasive hepatectomy (MIH) is increasingly utilized; however, predictors and outcomes for patients requiring conversion to an open procedure have not been adequately studied. Methods The 2014–15 ACS-NSQIP database was analyzed. Unplanned conversion was compared to successful MIH and elective open hepatectomy. Results Among 6918 hepatectomies, 1062 (15.4{\%}) underwent attempted MIH: 989 laparoscopic, 73 robotic. Conversion occurred in 203 (19.1{\%}). Compared to successful MIH, patients requiring unplanned conversion experienced higher rates of complications (34.5{\%} vs 14.6{\%}, p < 0.001), including bile leaks (7.4{\%} vs 2.8{\%}, p = 0.002), organ space infection (6.4{\%} vs 2.9{\%}, p = 0.016), UTI (4.9{\%} vs 1.2{\%}, p = 0.002), perioperative bleeding (21.2{\%} vs 6.1{\%}, p < 0.001), DVT (3.0{\%} vs 0.8{\%}, p = 0.024), and sepsis (5.9{\%} vs 1.9{\%}, p = 0.001). Conversion led to greater LOS (5 days vs 3 days, p < 0.001) and 30-day mortality (3.0{\%} vs 0.5{\%}, p = 0.005). Compared to elective open hepatectomy, conversion was associated with greater perioperative bleeding (21.2{\%} vs 15.3{\%}, p = 0.037). On multivariate analysis, major hepatectomy (OR 2.21, p < 0.001), concurrent ablation (OR 1.79, p = 0.020), and laparoscopic approach (vs. robotic) (OR 3.22, p = 0.014) were associated with conversion. Conclusion Analysis of this national database revealed unplanned conversion during MIH is associated with greater morbidity and mortality. MIH should be approached cautiously in patients requiring major hepatectomy.",
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T1 - Predictors and implications of unplanned conversion during minimally invasive hepatectomy

T2 - an analysis of the ACS-NSQIP database

AU - Stiles, Zachary E.

AU - Behrman, Stephen W.

AU - Glazer, Evan

AU - Deneve, Jeremiah

AU - Dong, Lei

AU - Wan, Jim

AU - Dickson, Paxton V.

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N2 - Background Minimally-invasive hepatectomy (MIH) is increasingly utilized; however, predictors and outcomes for patients requiring conversion to an open procedure have not been adequately studied. Methods The 2014–15 ACS-NSQIP database was analyzed. Unplanned conversion was compared to successful MIH and elective open hepatectomy. Results Among 6918 hepatectomies, 1062 (15.4%) underwent attempted MIH: 989 laparoscopic, 73 robotic. Conversion occurred in 203 (19.1%). Compared to successful MIH, patients requiring unplanned conversion experienced higher rates of complications (34.5% vs 14.6%, p < 0.001), including bile leaks (7.4% vs 2.8%, p = 0.002), organ space infection (6.4% vs 2.9%, p = 0.016), UTI (4.9% vs 1.2%, p = 0.002), perioperative bleeding (21.2% vs 6.1%, p < 0.001), DVT (3.0% vs 0.8%, p = 0.024), and sepsis (5.9% vs 1.9%, p = 0.001). Conversion led to greater LOS (5 days vs 3 days, p < 0.001) and 30-day mortality (3.0% vs 0.5%, p = 0.005). Compared to elective open hepatectomy, conversion was associated with greater perioperative bleeding (21.2% vs 15.3%, p = 0.037). On multivariate analysis, major hepatectomy (OR 2.21, p < 0.001), concurrent ablation (OR 1.79, p = 0.020), and laparoscopic approach (vs. robotic) (OR 3.22, p = 0.014) were associated with conversion. Conclusion Analysis of this national database revealed unplanned conversion during MIH is associated with greater morbidity and mortality. MIH should be approached cautiously in patients requiring major hepatectomy.

AB - Background Minimally-invasive hepatectomy (MIH) is increasingly utilized; however, predictors and outcomes for patients requiring conversion to an open procedure have not been adequately studied. Methods The 2014–15 ACS-NSQIP database was analyzed. Unplanned conversion was compared to successful MIH and elective open hepatectomy. Results Among 6918 hepatectomies, 1062 (15.4%) underwent attempted MIH: 989 laparoscopic, 73 robotic. Conversion occurred in 203 (19.1%). Compared to successful MIH, patients requiring unplanned conversion experienced higher rates of complications (34.5% vs 14.6%, p < 0.001), including bile leaks (7.4% vs 2.8%, p = 0.002), organ space infection (6.4% vs 2.9%, p = 0.016), UTI (4.9% vs 1.2%, p = 0.002), perioperative bleeding (21.2% vs 6.1%, p < 0.001), DVT (3.0% vs 0.8%, p = 0.024), and sepsis (5.9% vs 1.9%, p = 0.001). Conversion led to greater LOS (5 days vs 3 days, p < 0.001) and 30-day mortality (3.0% vs 0.5%, p = 0.005). Compared to elective open hepatectomy, conversion was associated with greater perioperative bleeding (21.2% vs 15.3%, p = 0.037). On multivariate analysis, major hepatectomy (OR 2.21, p < 0.001), concurrent ablation (OR 1.79, p = 0.020), and laparoscopic approach (vs. robotic) (OR 3.22, p = 0.014) were associated with conversion. Conclusion Analysis of this national database revealed unplanned conversion during MIH is associated with greater morbidity and mortality. MIH should be approached cautiously in patients requiring major hepatectomy.

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