Minimally invasive hepatectomy conversions: an analysis of risk factors and outcomes. Issue 2 (February 2018)

• Record Type: Journal Article
• Authors: Silva, Jack P.; Berger, Nicholas G.; Yin, Ziyan; Liu, Ying; Tsai, Susan; Christians, Kathleen K.; Clarke, Callisia N.; Mogal, Harveshp; Clark Gamblin, T.
• Is Part Of: HPB. Volume 20:Issue 2(2018)
• Page Start: 132
• Page End: 139
• Publication Date: 2018-02
• Subjects: Liver -- Diseases -- Periodicals; Biliary tract -- Diseases -- Periodicals; Pancreas -- Diseases -- Periodicals; 616.362005
• DOI: 10.1016/j.hpb.2017.06.006
• Languages: English
• ISSNs: 1365-182X

Abstract

Abstract: Background: Surgical approach may influence morbidity following hepatectomy. This study sought to compare outcomes in minimally invasive surgery (MIS), conversion from MIS to open, and planned open hepatectomy patients and analyze factors leading to conversion. Methods: The 2014 National Surgical Quality Improvement Program dataset was queried for patients undergoing hepatectomy. Patients were divided into three cohorts: MIS, open, or conversion. Propensity matching was performed to compare MIS vs. conversion (3:1) and open vs. conversion (8:1). The logistic regression model was used to identify odds ratios for conversion. Results: Patients undergoing conversion had a higher transfusion rate (26% vs. 9%, p < 0.001), longer length of stay (5 vs. 3 days, p < 0.001), and higher morbidity (38% vs. 18%, p < 0.001) than MIS patients. Patients who underwent conversion had similar short-term outcomes to those who had planned open procedures. Independent predictors of conversion included hypertension (OR 1.91; 95% CI 1.12–3.26) and right lobectomy (OR 20.23; 95% CI 3.74–109.35). Conclusion: Patients with hypertension and those undergoing right lobectomy had a higher risk of conversion to open procedure. Conversion resulted in higher morbidity and longer length of stay compared to MIS patients, but outcomes were similar to planned open procedures.