The advantages associated with the laparoscopic approach are lost when conversion is required.
Available predictive models have failed to show external validation.
Body surface area is a recently described risk factor not included in these models.
Dr Carlos Vaccaro and colleagues developed a clinical rule including body surface area for predicting conversion in patients undergoing elective laparoscopic colorectal surgery.
The team conducted the study at a single large tertiary care institution.
The researchers identified 916 patients who underwent surgery between 2004 and 2011.
Conversion rate was analyzed related to age, sex, obesity, disease location, type of disease, history of previous surgery, and body surface area.
|Conversion rates among the high risk group was 28% |
|Diseases of the Colon & Rectum|
The research team developed a predictive model for conversion with the use of logistic regression to identify independently associated variables, and derived a simple clinical prediction rule.
Internal validation of the model was performed by using bootstrapping.
The team found that the conversion rate was 10%.
Rectal disease, large patient size, and male sex were independently associated with higher odds of conversion.
The researchers observed that prediction rule identified 3 risk groups, including low risk, average risk, and high risk.
Conversion rates among these groups were 6%, 11%, and 28%.
Compared with the low-risk group, odds ratios for average- and high-risk groups were 2.2, and 6.4.
Dr Vaccaro's team concludes, "This predictive model, including body surface area, stratifies patients with different conversion risks and may help to inform patients, to select cases in the early learning curve, and to evaluate the standard of care."
"However, this prediction rule needs to be externally validated in other samples."