title: Factors associated with conversion from laparoscopic to open colectomy using the National Surgical Quality Improvement Program (NSQIP) database.
abstract: OBJECTIVE
  Conversion rates from laparoscopic to open colectomy and associated factors are traditionally reported in clinical trials or reviews of outcomes from experienced institutions. Indications and selection criteria for laparoscopic colectomy may be more narrowly defined in these circumstances. With the increased adoption of laparoscopy, conversion rates using national data need to be closely examined. The purpose of this study was to use data from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) to identify factors associated with conversion of laparoscopic to open colectomy at a national scale in the United States.
  
  
  METHODS
  The ACS-NSQIP Participant Use Data Files for 2006-2011 were used to identify patients who had undergone laparoscopic colectomy. Converted cases were identified using open colectomy as the primary procedure and laparoscopic colectomy as 'other procedure'. Preoperative variables were identified and statistics were calculated using sas version 9.3. Logistic regression was used to model the multivariate relationship between patient variables and conversion status.
  
  
  RESULTS
  Laparoscopy was successfully performed in 41 585 patients, of whom 2508 (5.8%) required conversion to an open procedure. On univariate analysis the following factors were significant: age, body mass index (BMI), American Society of Anesthesiologists (ASA) class, presence of diabetes, smoking, chronic obstructive pulmonary disease, ascites, stroke, weight loss and chemotherapy (P < 0.05). The following factors remained significant on multivariate analysis: age, BMI, ASA class, smoking, ascites and weight loss.
  
  
  CONCLUSIONS
  Multiple significant factors for conversion from laparoscopic to open colectomy were identified. A novel finding was the increased risk of conversion for underweight patients. As laparoscopic colectomy is become increasingly utilized, factors predictive of conversion to open procedures should be sought via large national cohorts.
authors.affiliation: Department of Surgery, Division of Gastrointestinal, Minimally Invasive and Bariatric Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.
authors.forename: A R
authors.initials: AR
authors.lastname: Bhama
authors.forename: M E
authors.initials: ME
authors.lastname: Charlton
authors.forename: M B
authors.initials: MB
authors.lastname: Schmitt
authors.forename: J W
authors.initials: JW
authors.lastname: Cromwell
authors.forename: J C
authors.initials: JC
authors.lastname: Byrn
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000758:Anesthesia / Q000145:classification; D001201:Ascites / Q000453:epidemiology; D015992:Body Mass Index; D001835:Body Weight; D003082:Colectomy / Q000379:methods*; D003107:Colorectal Surgery / Q000592:standards / Q000706:statistics & numerical data; D061887:Conversion to Open Surgery / Q000706:statistics & numerical data*; D016208:Databases, Factual / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D058996:Quality Improvement / Q000592:standards / Q000706:statistics & numerical data; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology; D014481:United States
keywords: Colectomy; conversion colorectal; laparoscopic; minimally invasive