Does conversion of a laparoscopic colectomy adversely affect patient outcome?

Sergio Casillas, Conor P. Delaney, Anthony J. Senagore, Karen Brady, Victor W. Fazio

Research output: Contribution to journalArticle

104 Citations (Scopus)

Abstract

PURPOSE: Conversion during laparoscopic colectomy varies in frequency according to the surgeon's experience and case selection. However, there remains concern that conversion is associated with increased morbidity and higher hospital costs. METHODS: From January 1999 to August 2002, 430 laparoscopic colectomies were performed by two surgeons, with 51 (12 percent) cases converted to open surgery. Converted cases were matched for operation and age to 51 open cases performed mostly by other colorectal surgeons from our department. Data collected included gender, American Society of Anesthesiology score, operative indication, resection type, operative stage at conversion, in-hospital complications, direct hospital costs, unexpected readmission within 30 days, and mortality. RESULTS: There were no significant differences between the groups for age (converted, 55 ± 19; open, 62 ± 16), male:female ratio (converted, 17:34; open, 23:28), or American Society of Anesthesiology score distribution. Indications for surgery were neoplasia (converted, 16; open, 31); diverticular disease (converted, 21; open, 13); Crohn's disease (converted, 12; open, 5); and other disease (converted, 2; open, 2). Operative times were similar (converted, 150 ± 56 minutes; open, 132 ± 48 minutes). Conversions occurred before defining the major vascular pedicle/ureter (50 percent), in relation to intracorporeal vascular ligation (15 percent), or during bowel transection or presacral dissection (35 percent). Specific indications for conversion were technical (41 percent), followed by adhesions (33 percent), phlegmon or abscess (23 percent), bleeding (6 percent), and failure to identify the ureter (6 percent). Median hospital stay was five days for both groups. In-hospital complications (converted 11.6 percent; open 8 percent), 30-day readmission rate (converted 13 percent vs. open 8 percent), and direct costs were similar between groups. There were no mortalities. CONCLUSION: Conversion of a laparoscopic colectomy does not result in inappropriately prolonged operative times, increased morbidity or length of stay, increased direct costs, or unexpected readmissions compared with similarly complex laparotomies. A policy of commencing most cases suitable for a laparoscopic approach laparoscopically offers patients the benefits of a laparoscopic colectomy without adversely affecting perioperative risks.

Original languageEnglish (US)
Pages (from-to)1680-1685
Number of pages6
JournalDiseases of the Colon and Rectum
Volume47
Issue number10
DOIs
StatePublished - Oct 2004
Externally publishedYes

Fingerprint

Colectomy
Anesthesiology
Hospital Costs
Ureter
Operative Time
Blood Vessels
Length of Stay
Morbidity
Costs and Cost Analysis
Cellulitis
Mortality
Crohn Disease
Laparotomy
Abscess
Ligation
Dissection
Age Groups
Hemorrhage
Surgeons
Neoplasms

Keywords

  • Conversion
  • Direct costs
  • Hospital stay
  • Laparoscopic colectomy
  • Morbidity
  • Mortality
  • Open colectomy
  • Operative times

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Casillas, S., Delaney, C. P., Senagore, A. J., Brady, K., & Fazio, V. W. (2004). Does conversion of a laparoscopic colectomy adversely affect patient outcome? Diseases of the Colon and Rectum, 47(10), 1680-1685. https://doi.org/10.1007/s10350-004-0692-4

Does conversion of a laparoscopic colectomy adversely affect patient outcome? / Casillas, Sergio; Delaney, Conor P.; Senagore, Anthony J.; Brady, Karen; Fazio, Victor W.

In: Diseases of the Colon and Rectum, Vol. 47, No. 10, 10.2004, p. 1680-1685.

Research output: Contribution to journalArticle

Casillas, S, Delaney, CP, Senagore, AJ, Brady, K & Fazio, VW 2004, 'Does conversion of a laparoscopic colectomy adversely affect patient outcome?', Diseases of the Colon and Rectum, vol. 47, no. 10, pp. 1680-1685. https://doi.org/10.1007/s10350-004-0692-4
Casillas, Sergio ; Delaney, Conor P. ; Senagore, Anthony J. ; Brady, Karen ; Fazio, Victor W. / Does conversion of a laparoscopic colectomy adversely affect patient outcome?. In: Diseases of the Colon and Rectum. 2004 ; Vol. 47, No. 10. pp. 1680-1685.
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N2 - PURPOSE: Conversion during laparoscopic colectomy varies in frequency according to the surgeon's experience and case selection. However, there remains concern that conversion is associated with increased morbidity and higher hospital costs. METHODS: From January 1999 to August 2002, 430 laparoscopic colectomies were performed by two surgeons, with 51 (12 percent) cases converted to open surgery. Converted cases were matched for operation and age to 51 open cases performed mostly by other colorectal surgeons from our department. Data collected included gender, American Society of Anesthesiology score, operative indication, resection type, operative stage at conversion, in-hospital complications, direct hospital costs, unexpected readmission within 30 days, and mortality. RESULTS: There were no significant differences between the groups for age (converted, 55 ± 19; open, 62 ± 16), male:female ratio (converted, 17:34; open, 23:28), or American Society of Anesthesiology score distribution. Indications for surgery were neoplasia (converted, 16; open, 31); diverticular disease (converted, 21; open, 13); Crohn's disease (converted, 12; open, 5); and other disease (converted, 2; open, 2). Operative times were similar (converted, 150 ± 56 minutes; open, 132 ± 48 minutes). Conversions occurred before defining the major vascular pedicle/ureter (50 percent), in relation to intracorporeal vascular ligation (15 percent), or during bowel transection or presacral dissection (35 percent). Specific indications for conversion were technical (41 percent), followed by adhesions (33 percent), phlegmon or abscess (23 percent), bleeding (6 percent), and failure to identify the ureter (6 percent). Median hospital stay was five days for both groups. In-hospital complications (converted 11.6 percent; open 8 percent), 30-day readmission rate (converted 13 percent vs. open 8 percent), and direct costs were similar between groups. There were no mortalities. CONCLUSION: Conversion of a laparoscopic colectomy does not result in inappropriately prolonged operative times, increased morbidity or length of stay, increased direct costs, or unexpected readmissions compared with similarly complex laparotomies. A policy of commencing most cases suitable for a laparoscopic approach laparoscopically offers patients the benefits of a laparoscopic colectomy without adversely affecting perioperative risks.

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KW - Morbidity

KW - Mortality

KW - Open colectomy

KW - Operative times

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