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Does conversion of a laparoscopic colectomy adversely affect patient outcome?
Sergio Casillas1, Conor P Delaney, Anthony J Senagore
1Department of Colorectal Surgery, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
Diseases of the Colon and Rectum
|November 13, 2004
Summary
Conversion during laparoscopic colectomy does not increase risks or costs compared to open surgery. This suggests laparoscopic colectomy can be safely performed for most patients, offering benefits without adverse perioperative outcomes.
Area of Science:
- Colorectal Surgery
- Minimally Invasive Surgery
- Surgical Outcomes Research
Background:
- Laparoscopic colectomy conversion rates vary based on surgeon experience and case selection.
- Concerns exist regarding increased morbidity and hospital costs associated with conversion from laparoscopic to open colectomy.
Purpose of the Study:
- To compare perioperative outcomes, including morbidity, costs, and readmissions, between converted laparoscopic colectomies and open colectomies.
- To evaluate the impact of surgeon experience and case selection on conversion rates and outcomes.
Main Methods:
- A retrospective review of 430 laparoscopic colectomies performed between January 1999 and August 2002.
- Matching 51 converted cases with 51 open colectomy cases based on operation type and patient age.
- Collecting data on demographics, American Society of Anesthesiology scores, indications, operative details, complications, costs, readmissions, and mortality.
Main Results:
- No significant differences were observed in age, gender ratio, or ASA scores between converted and open groups.
- Operative times were similar (150+/-56 min vs. 132+/-48 min).
- In-hospital complications (11.6% vs. 8%), 30-day readmission rates (13% vs. 8%), and direct costs were comparable. No mortalities occurred in either group.
Conclusions:
- Conversion from laparoscopic to open colectomy does not lead to prolonged operative times, increased morbidity, longer hospital stays, higher costs, or more readmissions compared to open laparotomy.
- Adopting a policy of performing laparoscopic colectomies for suitable cases offers patient benefits without compromising perioperative safety.