[Factors associated with laparoscopic approach for cholecystectomy, appendicectomy and inguinal herniorraphy in France].
OBJECTIVE
To determine on a national level the factors associated with the use of laparoscopy for digestive surgery.


METHODS
Nation wide study using a large representative sample (3 days of anaesthesia in France).


METHODS
Univariate followed by multivariate analyses of data gathered in 1996 during the survey led by the French Society of Anaesthesia and Intensive care ("SFAR") including 2847 surgical procedures for cholecystectomy, appendicectomy or inguinal herniorraphy.


RESULTS
Independent factors associated with the use of laparoscopy were: for cholecystectomy: age (less frequent when > or =71 years: adjusted Odds ratio [AOR] 0.4), sex (more frequent in female: AOR 1.7), ASA physical status (less frequent when > or =3: AOR 0.5), private hospital (AOR 2.0), procedure scheduled at least the night before (AOR 2.1), and use of closed circuit general anaesthesia (AOR 1.6); for appendectomy: age >15 years (AOR 1.9-2.2), female (AOR 2.1), private hospital (AOR 2.7), scheduled procedure (AOR 2.1), prolonged procedure (AOR 8.4), endotracheal intubation (AOR 16.7), and closed circuit (AOR 2.7); for inguinal herniorraphy: ASA physical status (less frequent when > or =3: AOR 0.4), private hospital (AOR 3.4), prolonged procedure (AOR 5.6), and endotracheal intubation (AOR 21.6). Association with a closed circuit was confirmed for general anaesthesia using a volatile agent (AOR 1.5). Overall, ambulatory surgery was rarely performed and used only for open procedures. Regional anaesthesia was used only for inguinal open herniorraphy.


CONCLUSIONS
These data obtained from a large national survey confirmed the higher frequency of laparoscopy in middle aged patients, female (except for inguinal herniorraphy), without important comorbidity, in private hospitals. Laparoscopy was associated with prolonged procedures and with a change in the anaesthetic technique for appendicectomy and inguinal herniorraphy: tracheal intubation was almost constantly used. Whatever the procedure, closed circuit anaesthesia was more frequently used when surgery was performed under laparoscopy, reflecting newer equipment of the hospital, private or public.
Lienhart
A
A
Service d'anesthésie-réanimation, centre hospitalier universitaire Saint-Antoine, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France. andre.lienhart@sat.ap-hop-paris.fr
Péquignot
F
F
Auroy
Y
Y
Benhamou
D
D
Clergue
F
F
Laxenaire
M C
MC
Jougla
E
E
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000556:Ambulatory Surgical Procedures; D000764:Anesthesia, Closed-Circuit; D000768:Anesthesia, General; D018685:Anesthetics, Inhalation; D001062:Appendectomy / Q000706:statistics & numerical data*; D002648:Child; D002675:Child, Preschool; D017081:Cholecystectomy, Laparoscopic / Q000706:statistics & numerical data*; D003625:Data Collection; D003657:Decision Making; D013505:Digestive System Surgical Procedures / Q000706:statistics & numerical data*; D017558:Elective Surgical Procedures; D005260:Female; D005602:France / Q000453:epidemiology; D006552:Hernia, Inguinal / Q000453:epidemiology / Q000601:surgery*; D016304:Hospitals, Private; D006801:Humans; D007223:Infant; D007442:Intubation, Intratracheal; D010535:Laparoscopy / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D012737:Sex Factors
D018685:Anesthetics, Inhalation