Risk Factors and Outcomes for Conversion to Laparotomy of Laparoscopic Hysterectomy in Benign Gynecology.
To estimate the incidence and factors for conversion to laparotomy in women scheduled for laparoscopic hysterectomy for benign gynecologic indications and to examine the effect of conversion on patient outcomes.



A retrospective cohort study of a Michigan multicenter prospective database was abstracted from January 1, 2013, through July 2, 2014. Participants were collected from an all-payer quality and safety database maintained by the Michigan Surgical Quality Collaborative. Women with a preoperative indication of cancer or obstetric indications were excluded. A logistic regression model was used to calculate odds of conversion using patient preoperative and intraoperative attributes.



During the study period, 6,992 women underwent an attempted laparoscopic hysterectomy with 3.93% (n=275) converted to laparotomy. After adjusting for socioeconomic differences, hysterectomy indication, and intraoperative factors, there were decreased odds of conversion to laparotomy with use of robotic-assisted laparoscopy compared with traditional laparoscopy (adjusted odds ratio [OR] 0.14, 95% confidence interval [CI] 0.07-0.25) with a predicted risk of conversion of 0.8% compared with 5.4% (P<.001). High-volume surgeons were less likely to convert to laparotomy compared with low- and medium-volume surgeons (adjusted OR 0.66, 95% CI 0.47-0.92) with a predicted risk of conversion of 1.4% compared with 2.25% (P=.015). Conversion was associated with moderate or severe adhesive disease and increasing specimen weight. Conversion was associated with increased rates of surgical site infection, blood transfusion, severe sepsis, and reoperation.



This analysis demonstrates that conversion to laparotomy is associated with increased odds of postoperative morbidity, and robotic assistance and surgeon volume are strongly associated with decreased odds of conversion.
Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan.
Courtney S
CS
Lim
Erika L
EL
Mowers
Nichole
N
Mahnert
Bethany D
BD
Skinner
Neil
N
Kamdar
Daniel M
DM
Morgan
Sawsan
S
As-Sanie
D000328:Adult; D001803:Blood Transfusion; D002983:Clinical Competence / Q000706:statistics & numerical data*; D061887:Conversion to Open Surgery / Q000009:adverse effects* / Q000706:statistics & numerical data*; D005260:Female; D005831:Genital Diseases, Female / Q000601:surgery*; D006801:Humans; D007044:Hysterectomy / Q000379:methods*; D010535:Laparoscopy; D008824:Michigan; D008875:Middle Aged; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D065287:Robotic Surgical Procedures / Q000706:statistics & numerical data*; D018805:Sepsis / Q000209:etiology; D013530:Surgical Wound Infection / Q000209:etiology; D000267:Tissue Adhesions / Q000209:etiology