Abstract
BackgroundConversion rates during minimally invasive surgery are generally examined in the limited scope of a particular procedure. However, for a hospital or payor, the cumulative impact of conversions during commonly performed procedures could have a much larger negative effect than what is appreciated by individual surgeons. The aim of this study is to assess open conversion rates during minimally invasive surgery (MIS) across common procedures using laparoscopic/thoracoscopic (LAP/VATS) and robotic-assisted (RAS) approaches.Study designRetrospective cohort study using the Premier Database on patients who underwent common operations (hysterectomy, lobectomy, right colectomy, benign sigmoidectomy, low anterior resection, inguinal and ventral hernia repair, and partial nephrectomy) between January 2013 and September 2015. ICD-9 and CPT codes were used to define procedures, modality, and conversion. Propensity scores were calculated using patient, hospital, and surgeon characteristics. Propensity-score matched analysis was used to compare conversions between LAP/VATS and RAS for each procedure.ResultsA total of 278,520 patients had MIS approaches of the ten operations. Conversion occurred in 5% of patients and was associated with a 1.77 day incremental increase in length of stay and $3441 incremental increase in cost. RAS was associated with a 58.5% lower rate of conversion to open surgery compared to LAP/VATS.ConclusionAt a health system or payer level, conversion to open is detrimental not just for the patient and surgeon but also puts a significant strain on hospital resources. Use of RAS was associated with less than half of the conversion rate observed for LAP/VATS.
Highlights
Conversion rates during minimally invasive surgery are generally examined in the limited scope of a particular procedure
551,975 patients met selection criteria (Figure 1), which included open and minimally invasive surgery (MIS) approaches, and were included in the study (Table 1): 181,343 (33%) patients had hysterectomy for benign conditions, 14,572 (3%) had hysterectomy for endometrial cancer, 18,900 (3%) had sigmoidectomy for diverticular disease, 7149 (1%) had low anterior resection for rectal cancer, 17,968 (3%) had right colectomy for benign conditions, 12,836 (2%) had right colectomy for malignant conditions, 139,608 (25%) had inguinal hernia repair, 136,817 (25%) had ventral hernia repair, 15,395 (3%) had lobectomy for primary lung cancer, and 7387 (1%) had partial nephrectomy for kidney cancer
Our data indicate that the conversion rate to laparotomy or thoracotomy varies considerably among different procedures, but there is consistent, detrimental impact on length of stay, readmissions, and 30-day costs
Summary
Conversion rates during minimally invasive surgery are generally examined in the limited scope of a particular procedure. The aim of this study is to assess open conversion rates during minimally invasive surgery (MIS) across common procedures using laparoscopic/thoracoscopic (LAP/VATS) and robotic-assisted (RAS) approaches. Propensityscore matched analysis was used to compare conversions between LAP/VATS and RAS for each procedure. RAS was associated with a 58.5% lower rate of conversion to open surgery compared to LAP/VATS. Conclusion At a health system or payer level, conversion to open is detrimental not just for the patient and surgeon and puts a significant strain on hospital resources. Use of RAS was associated with less than half of the conversion rate observed for LAP/VATS
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