D. Asuzu1, G. Chao1, K. Y. Pei1 1Yale University School Of Medicine,General Surgery,New Haven, CT, USA
Introduction:
Laparoscopic lysis of adhesion (LLOA) for small bowel obstruction (SBO) is associated with shorter operative times and lower complication rates compared to open lysis of adhesion (OLOA). However, intra-operative conversion from LLOA to OLOA still occurs even at experienced centers. Factors associated with this conversion remain poorly understood.
Methods:
We retrospectively analyzed data from 9,920 patients undergoing OLOA (CPT 44005) for SBO (ICD10 560.81 and 560.9) in the prospectively collected American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database from 2005 to 2013. 92 cases were converted from LLOA to OLOA. Factors independently associated with conversion were identified using multivariable logistic regression adjusting for age, gender, weight and pre-operative functional status.
Results:
Age and weight were significant risk factors for conversion from LLOA to OLOA, with adjusted odds ratio (OR) per decade of 0.86, 95% confidence interval (CI) 0.76 – 0.97, P = 0.017; and adjusted OR per 50 lbs of 1.24, 95% CI 1.01 – 1.52, P = 0.048 respectively. Other factors significantly associated with conversion from LLOA to OLOA included pre-operative albumin, (adjusted OR 1.60, 95% CI 1.16 – 2.22, P = 0.005), aspartate aminotransferase (AST, adjusted OR 1, 95% CI 1 – 1.01, P = 0.038) and white blood cell (WBC) count (adjusted OR 0.93, 95% CI 0.88 – 0.99, P = 0.018).
Conclusions:
Patients who are younger but weigh more are more likely to be converted from LLOA to OLOA. Patients with higher synthetic liver function and patients with high transaminases and lower WBC counts are also more likely to be converted from LLOA to OLOA. Our results warrant verification in large independent prospective datasets.