Details

Autor(en) / Beteiligte

• Twijnstra, Andries R.H., MD
• Blikkendaal, Mathijs D., MD
• van Zwet, Erik W., PhD
• Jansen, Frank W., MD, PhD

Titel

Clinical Relevance of Conversion Rate and its Evaluation in Laparoscopic Hysterectomy

Ist Teil von

• Journal of minimally invasive gynecology, 2013, Vol.20 (1), p.64-72

Ort / Verlag

United States: Elsevier Inc

Erscheinungsjahr

2013

Link zum Volltext

Quelle

MEDLINE

Beschreibungen/Notizen

• Abstract Study Objectives To estimate the current conversion rate in laparoscopic hysterectomy (LH); to estimate the influence of patient, procedure, and performer characteristics on conversion; and to hypothesize the extent to which conversion rate can act as a means of evaluation in LH. Design Prospective cohort study (Canadian Task Force classification II-2). Setting The study included 79 gynecologists representing 42 hospitals throughout the Netherlands. This reflects 75% of all gynecologists performing LH in the Netherlands, and 68% of all hospitals. Patients Data from 1534 LH procedures were collected between 2008 and 2010. Intervention All participants in the nationwide LapTop registration study recorded each consecutive LH they performed during 1 year. Measurements and Main Results Conversion rate and odds ratios (OR) of risk factors for conversion were calculated. Conversions were described as reactive or strategic. The literature reported a conversion rate for LH of 0% to 19% (mean, 3.5%). In our cohort, 70 LH procedures (4.6%) were converted. Using a mixed-effects logistic regression model, we estimated independent risk factors for conversion. Body mass index (BMI) (p = .002), uterus weight (p < .001), type of LH (p = .004), and age (p = .02) had a significant influence on conversion. The risk of conversion was increased at BMI >35 (OR, 6.53; p < .001), age >65 years (OR, 6.97; p = .007), and uterus weight 200 to 500 g (OR, 4.05; p < .001) and especially >500 g (OR, 30.90; p < .001). A variation that was not explained by the covariates included in our model was identified and referred to as the “surgical skills factor” (average OR, 2.79; p = .001). Conclusion Use of estimated risk factors (BMI, age, uterus weight, and surgical skills) provides better insight into the risk of conversion. Conversion rate can be used as a means of evaluation to ensure better outcomes of LH in future patients.