■腹腔镜治疗妇科肿块和癌症的一个众所周知的并发症是需要进行术中转换为剖腹手术。这项研究的目的是确定新的患者风险因素,从微创手术转换为开放手术的妇科肿瘤手术。
这是一项回顾性队列研究,纳入了2015年2月至2020年5月期间在单一学术医疗中心接受妇科肿块或恶性肿瘤手术的1356名≥18岁患者。多变量logistic回归用于研究年龄,较高的体重指数(BMI),高等美国麻醉师协会(ASA)的身体状况,术前血红蛋白(Hb)降低了从微创手术转换为开放手术的几率。接收器工作特征(ROC)曲线分析评估了风险预测模型对转换的判别能力。
■总共包括704个计划的微创手术,总转化率为6.1%(43/704)。转换病例的术前Hb最低,与微创和开放病例相比(11.6±1.9vs12.8±1.5vs11.8±1.9g/dL,p<.001)。术前Hb<10g/dL的患者转换的校正比值比(OR)为3.94(CI:1.65-9.41,p=.002),而BMI≥30kg/m2的患者转换的校正OR为2.86(CI:1.50-5.46,p=.001)。使用年龄>50岁的预测变量进行ROC曲线分析,BMI≥30kg/m2,ASA身体状况>2,术前血红蛋白<10g/dL导致ROC曲线下面积为0.71。具有2个或更多危险因素的患者需要术中转换的风险最高(12.0%)。
■术前血红蛋白降低是从微创性妇科肿瘤手术转变为开放性妇科肿瘤手术的一个新的危险因素,根据转变风险对患者进行分层可能有助于术前规划。
妇科肿块(影响女性生殖器官的肿块)的微创手术通常比更具侵入性的手术更受欢迎。因为它涉及较小的手术切口,可以有整体更好的恢复时间。然而,微创手术的一个不必要的并发症是需要意外地将手术转换为开放手术,这需要更大的切口,并且是更高风险的手术。在我们的研究中,我们旨在发现与微创手术转换为开放手术风险较高相关的患者特征.我们的研究发现术前血红蛋白水平较低,在红细胞内携带氧气的蛋白质,与较高的转化风险相关。这个新的风险因素与其他已知的风险因素一起使用,包括有更高的年龄,较高的体重指数,和更高的基线医疗复杂性,以创建一个模型,以帮助手术团队识别高风险患者的转换。该模型可用于手术前和手术期间的手术计划以改善患者结果。
UNASSIGNED: A well-known complication of laparoscopic management of gynaecologic masses and cancers is the need to perform an intraoperative conversion to laparotomy. The purpose of this study was to identify novel patient risk factors for conversion from minimally invasive to open surgeries for gynaecologic oncology operations.
UNASSIGNED: This was a retrospective cohort study of 1356 patients ≥18 years of age who underwent surgeries for gynaecologic masses or malignancies between February 2015 and May 2020 at a single academic medical centre. Multivariable logistic regression was used to study the effects of older age, higher body mass index (BMI), higher American Society of Anaesthesiologist (ASA) physical status, and lower preoperative haemoglobin (Hb) on odds of converting from minimally invasive to open surgery. Receiver operating characteristic (ROC) curve analysis assessed the discriminatory ability of a risk prediction model for conversion.
UNASSIGNED: A total of 704 planned minimally invasive surgeries were included with an overall conversion rate of 6.1% (43/704). Preoperative Hb was lowest for conversion cases, compared to minimally invasive and open cases (11.6 ± 1.9 vs 12.8 ± 1.5 vs 11.8 ± 1.9 g/dL, p<.001). Patients with preoperative Hb <10 g/dL had an adjusted odds ratio (OR) of 3.94 (CI: 1.65-9.41, p=.002) for conversion while patients with BMI ≥30 kg/m2 had an adjusted OR of 2.86 (CI: 1.50-5.46, p=.001) for conversion. ROC curve analysis using predictive variables of age >50 years, BMI ≥30 kg/m2, ASA physical status >2, and preoperative haemoglobin <10 g/dL resulted in an area under the ROC curve of 0.71. Patients with 2 or more risk factors were at highest risk of requiring an intraoperative conversion (12.0%).
UNASSIGNED: Lower preoperative haemoglobin is a novel risk factor for conversion from minimally invasive to open gynaecologic oncology surgeries and stratifying patients based on conversion risk may be helpful for preoperative planning.
Minimally invasive surgery for management of gynaecologic masses (masses that affect the female reproductive organs) is often preferred over more invasive surgery, because it involves smaller surgical incisions and can have overall better recovery time. However, one unwanted complication of minimally invasive surgery is the need to unexpectedly convert the surgery to an open surgery, which entails a larger incision and is a higher risk procedure. In our study, we aimed to find patient characteristics that are associated with higher risk of converting a minimally invasive surgery to an open surgery. Our study identified that lower levels of preoperative haemoglobin, the protein that carries oxygen within red blood cells, is correlated with higher risk for conversion. This new risk factor was used with other known risk factors, including having higher age, higher body mass index, and higher baseline medical complexity to create a model to help surgical teams identify high risk patients for conversion. This model may be useful for surgical planning before and during the operation to improve patient outcomes.