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Predictors and Consequences of Unplanned Conversion to Open During Robotic Colectomy: An ACS-NSQIP Database Analysis
Andrew N Mueller1, John D Vossler1, Nicholas H Yim2
1Department of Surgery, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI (ANM, JDV, KMM).
Hawai'I Journal of Health & Social Welfare
|November 25, 2021
Summary
Unplanned conversion during robotic colectomy increases patient mortality and morbidity. Identifying predictors of conversion can help mitigate risks associated with this surgical approach.
Area of Science:
- Surgical Innovation
- Minimally Invasive Surgery
- Patient Outcomes Research
Background:
- Robotic-assisted surgery is increasingly preferred for colectomy.
- Unplanned conversion to open surgery may negatively impact patient outcomes.
Purpose of the Study:
- To identify predictors of unplanned conversion to open surgery during robotic colectomy.
- To assess the consequences of unplanned conversion on patient morbidity and mortality.
Main Methods:
- Retrospective analysis of 11,061 robotic colectomies from the ACS-NSQIP database (2012-2017).
- Multivariate logistic regression used to analyze predictors and outcomes of conversion.
- Risk-adjusted odds ratios calculated for conversion and adverse events.
Main Results:
- 6.2% of robotic colectomies (689/11,061) required unplanned conversion.
- Predictors included advanced age, male gender, obesity, poor functional status, high ASA class, non-oncologic indication, emergency status, smoking, weight loss, bleeding disorders, and preoperative infection.
- Conversion independently increased risks of mortality, overall morbidity, specific morbidities (cardiac, pulmonary, renal, wound), sepsis, bleeding, readmission, reoperation, and extended length of stay.
Conclusions:
- Unplanned conversion to open surgery is an independent risk factor for adverse outcomes after robotic colectomy.
- Patient and disease-specific factors predict conversion risk.
- Minimizing unplanned conversions may improve patient safety and surgical outcomes.
