Predictive Factors For Conversion Research Articles

Predictive Factors for Converting Endoscopic to Open Carpal Tunnel Release

Introduction: Both open and endoscopic methods of carpal tunnel release are accepted treatments for carpal tunnel syndrome. The objective was to determine the endoscopic to open conversion rate of all carpal tunnel surgeries. We evaluated potential predictive factors for an increased rate of conversion. Methods: The IRB/IRBnet approved (#20210613/1639264) a retrospective chart review of all attempted endoscopic carpal tunnel surgeries performed from July 1, 2012 through June 30, 2021. Charts were reviewed for procedure, age, sex, body mass index (BMI), electromyograph (EMG) reading, wrist arthritis on x-ray, preoperative steroid injections, trainee as surgeon, diabetes, hand dominance, and operated side. Conversion rate was noted. A chi-square test using a P-value of <0.05 was used to determine the statistical significance of the patients’ age, sex, BMI, EMG severity, the presence of wrist arthritis, preoperative steroid injections, resident as surgeon, diabetic status, and operated hand dominance as predictive factors for conversion. Results: The plastic surgery service attempted 1053 endoscopic carpal tunnel releases using the Chow dual port technique over a 9-year period. Forty-five cases converted to an open release. Median age ( P = 0.54), sex ( P = 0.43), median BMI ( P = 0.76), EMG severity ( P = 0.20), wrist arthritis ( P = 1.0), preoperative steroid injections ( P = 0.65), resident surgeon ( P = 0.53), diabetes ( P = 0.50), and operated hand dominance ( P = 0.36) were not statistically significant predictive risk factors. Nineteen of 45 converted cases had a future successful contralateral endoscopic release. Conclusion: Our study found a 4.27% endoscopic to open conversion rate. No identifiable risk factors could predict conversion. Prior conversion does not determine a future contralateral conversion.

Predictive factors for conversion from conservatively to surgically treatment osteoporotic thoracolumbar compression fractures based on sagittal parameters and magnetic resonance imaging features.

To investigate the relationship between sagittal plane characteristics of the spinal column and conservative treatment failure in acute osteoporotic spinal fractures (OSFs). As a retrospective study of single-institute data, thoracolumbar OSF patients with similar propensities in terms of location of fractures and results of bone mineral density were analyzed. Among them, 43 patients (group I) who needed reconstructive surgical interventions and 39 patients (group II) who obtained successful treatment through conservative care were included. General demographic data, radiographic features of fractures, and magnetic resonance imaging (MRI) features of fractures were analyzed. To investigate the relationship between global sagittal alignment of the spine and occurrence of delayed complication following OSFs, radiological sagittal parameters were analyzed. The number of cases requiring reconstructive surgery was significantly higher when the index vertebra showed diffuse or mid-portion bone marrow changes in MRI. In terms of sagittal parameters, pelvic incidence (group I 59.1° ± 11.9°, group II 54.6° ± 9.8°) and thoracolumbar angle (group I 26.5° ± 14.1°, group II 17.4° ± 11.2°) were significantly higher in group I. Logistic regression analysis showed that higher pelvic incidence (OR 1.09, 95% CI 1.01-1.18, p value < 0.05) and higher thoracolumbar angle (OR 1.09, 95% CI 1.02-1.17, p value < 0.05) were significant risk factors for delayed complications requiring reconstructive surgery following OSFs. Delayed complications requiring reconstructive surgery following OSFs are related to sagittal plane parameters of the spine such as high pelvic incidences, in addition to previously known radiographic characteristics of fractures.

Predictive Factors for Conversion from Laparoscopic Adrenalectomy to Open Surgery: A 9-Year Review of 911 Cases.

Background: With the development of minimally invasive techniques, laparoscopic adrenalectomy (LA) has become the standard for the treatment of adrenal surgical diseases, but conversion to open adrenalectomy (OA) is also necessary in some cases. The purpose of this study was to investigate the risk factors for conversion from LA to OA. Methods: A retrospective study was performed on 911 patients who were diagnosed with adrenal tumors and underwent LA in the Department of Urology, Second Hospital of Lanzhou University from January 2013 to December 2021. According to the surgical methods, the patients were divided into the laparoscopic group (n = 873) and the conversion group (n = 38). Logistic regression was used to analyze the independent risk factors of conversion, and the logistic regression equation was established to predict the probability of conversion. Results: In this study, 38 patients (4.17%) were converted to open. In the univariate analysis, body mass index (P = .037), tumor side (P < .001), tumor size (P < .001), surgical approach (P < .001), and histological type (P = .006) were significantly associated with conversion. In the multivariate analysis, tumor diameter >7 cm (odds ratio = 2.835, 95% confidence interval 1.096-7.335; P = .032), transabdominal approach (odds ratio = 2.400, 95% confidence interval 1.136-5.074; P = .022), pheochromocytoma (odds ratio = 5.018, 95% confidence interval 1.964-12.822; P = .001), and malignant tumor (odds ratio = 17.781, 95% confidence interval 4.156-76.075; P < .001) were independent risk factors for transition opening. The logistic regression equation showed good power to predict conversion. Conclusion: Tumor size, surgical approach, and histological type were predictive factors for conversion from a laparoscopic to an open procedure. Preoperative evaluation of these characteristics is of great value for clinicians to evaluate the risk of conversion and make a surgical plan. It can not only reduce the conversion rate but also help to improve the intraoperative situation and shorten the length of hospital stays.

Laparoscopic retroperitoneal approach for urinary tract surgery. Predictive factors of complications and conversion to open surgery

Introduction: Surgery by lumboscopic approach is of choice for some work groups, despite being more arduous and requiring a higher learning curve.&#x0D; Objective: To assess the lumboscopic approach and identify predictive factors of complications and conversion to open surgery.&#x0D; Material and Methods: A transversal, retrospective study of 436 patients that underwent surgery by lumboscopy at the National Center for Minimally Invasive Surgery, 2008-2019. Absolute and relative frequencies; the Chi-Square Test and Student´s t Test and the Multiple Logistics Regression, were utilized, (p≤0.05).&#x0D; Results: Renal atrophy due to benign diseases (49.8%), renoureteral lithiasis (26.6%), surgery of moderate complexity (71.9%) prevailed, such as nephrectomy (50.2%). 16.1% had undergone prior surgery, and 12.4% a urinary derivation. 3% required conversion to open surgery and 18.8% presented complications. Renal staghorn and non-staghorn lithiasis, surgical technique, level of complexity of the surgery, operative time, transoperative bleeding and length of hospital stay were significantly associated (p&lt;0.05) to complications, but after measuring logistics regression, only hospital stay resulted statistically significant (p=0.000). Regarding conversion: gender, past history of prior surgery, operative time and bleeding were significantly associated (p&lt;0.05) in both the univariate and multivariate analysis.&#x0D; Conclusions: Nephrectomy due to benign causes and surgeries of moderate complexity prevailed in this series. The perioperative outcomes were satisfactory and the most frequent complications were postoperative, infectious and of grade II severity. Longer hospital stay was a predictive factor for complications whereas males, past history of prior surgery, longer operative time and bleeding were identified as predictive factors for conversion to open surgery.

The usefulness of modified splenic hilum hanging maneuver in laparoscopic splenectomy, especially for patients with huge spleen: a case-control study with propensity score matching.

Although Laparoscopic splenectomy (LS) have been proven to the standard operation for removal of spleen, the rate of conversion to open surgery is still higher than those of other laparoscopic surgeries, especially for huge spleen. In order to reduce the rate of conversion to open surgery, we had developed LS using modified splenic hilum hanging (MSHH) maneuver: the splenic pedicle was transected en bloc using a surgical stapler after hanging splenic hilum with an atraumatic penrose drain tube. Between January 2005 and December 2019, we retrospectively assessed 94 patients who underwent LS. MSHH maneuver was performed in 37 patients (39.4%). We compared the intra- and postoperative outcomes between patients with or without MSHH maneuver. To adjust for differences in preoperative characteristics and blood examination, propensity score matching was used at a 1:1 ratio, resulting in a comparison of 29 patients per group. Predictive factors of conversion from LS to open surgery were elucidated using the uni- and multi-variate analyses. After the propensity score matching, blood loss (268ml vs. 50ml), the rate of conversion to open surgery (27.6% vs. 0%), and postoperative hospital stays (15days vs. 10days) were significantly decreased in patients with MSHH maneuver, respectively. Among 94 patients, 19 patients (20.2%) underwent conversion to open surgery. In multivariate analysis, spleen volume (SV) and LS without MSHH maneuver were independent predictive factors of conversion to open surgery, respectively. Additionally, cut-off value of SV for conversion to open surgery was 802ml (sensitivity: 0.684, specificity: 0.827, p < 0.001). LS using MSHH maneuver seems to be useful surgical technique to improve intraoperative outcomes and reduce the rate of conversion from LS to open surgery resulting in shorten postoperative hospital stay.

Predictive factors of conversion in laparoscopic cholecystectomy for acute calculous cholecystitis

Purpose: Identify the predictive factors for conversion and to evaluate conversion’s impact on postoperative morbidity and mortality. Method: A retrospective study in the surgical department at Mongi Slim Hospital. We enrolled 300 patients who underwent LC for ACC between January 2015 and December 2018. Patients were divided into two groups: “Laparoscopy” for the 282 successful Laparoscopic cholecystectomies (LC) and “Conversion” for the 18 Convertions to open (CTO). A descriptive analysis of preoperative, intraoperative and postoperative data was performed, followed by a bivariate and a multivariate analysis comparing the two groups. The significance level was set at 0.05. Results: The conversion rate was 6%. The sex-ratio was 0.47. The median age was 50 years with interquartile range of 38-62 years. Bivariate analysis identified the following factors: male gender (p=0.001), age over 57 years (p=0.002), right upper quadrant tenderness (p=0.009), right upper quadrant guarding (p=0.006), leukocytosis ≥ 18000 cells /mL (p=0.002), leukopenia (<0.001), serum creatinine level > 20 mg/L (p=0.045), ultrasonographic findings like laminated gallbladder wall (p=0.033), pericholecystic abscess (p=0.045), liver abscess (p<0.001), intra-abdominal effusion (p=0.001), ACC grade II (p=0.009) and intraoperative findings like pericholecystic adhesions (p<0.001), gangrenous ACC (p=0.001), pericholecystic abscess (p=0.005), localized peritonitis (p=0.028), pediculitis (p=0.006), difficulties in identifying anatomical structures (p=0.014) and bile duct injuries (p<0.001). Multivariate analysis determined as predictive factors: male gender (OR=3.715; 95% CI [1.101-12.541]; p=0.03) and age over 57 years (OR=1.038; 95% CI [1-1.077]; p=0.04). There were no differences between the two groups in terms of postoperative morbidity and mortality. However, CTO was associated with a prolonged length of stay (p=0.02). Conclusion: The predictive factors of CTO are not modifiable. Their identification may help conduct a better communication with the patient and optimize the planning of the procedure.

Assessment of predictive factors for difficult laparoscopic cholecystectomy

Background: The present study was conducted to assess predictive factors for difficult laparoscopic cholecystectomy. Materials & Methods: 84 patients having symptomatic gallstone disease were included. After the surgery, patients were group into 2 groups those who had a successful laparoscopic cholecystectomy and those cases who had conversion to open cholecystectomy. Results: Total 6 cases underwent conversion. Out of 15 patients with age >50 years, 3 underwent conversion and out of 69 patients with age 50 years were predictive factors for conversion.

Conversion due to vascular injury during video-assisted thoracic surgery lobectomy: A multicentre retrospective analysis from the Italian video-assisted thoracic surgery group registry

ObjectivesVascular injuries are among the most severe causes of unplanned conversion during VATS lobectomies. The study aimed to analyse the incidence of vascular injuries and their risk factors during VATS lobectomy. MethodsThe Italian VATS lobectomy Registry was used to collect data from 66 Thoracic Surgery Units. From 2013 to October 2016 (out of more than 3,700 patients enrolled) only information from Units with an enrollment >100 VATS lobectomies were retrospectively analysed. Logistic regression analysis was performed on selected variables of the univariate analysis. ResultsTen institutions contributed a total of 1,679 patients. Vascular injuries leading to conversion occurred in 44 (2.6%) patients. Years of experiences were inversely related to the risk of vascular injuries. Univariate analysis showed age, gender, surgical activity, Charlson Index Score and number of resected lymph nodes like significantly associated variables. Multivariate analysis revealed that number of resected lymph nodes, VATS experience ratio (number of VATS lobectomies/total lobectomies performed in the same year at same centre), and surgical activity of the centre were significantly associated with the risk of conversion. Unplanned thoracotomy was correlated with postoperative morbidity. ConclusionVascular injuries in VATS lobectomies represented a rare complication which could directly affect the postoperative outcomes. The predictive factors for conversion were multifactorial and depended on characteristics of centres and surgeons’ seniority. Minimally invasive VATS lobectomy approaches did not influence the risk of vascular damages.

Predictive factors for conversion from laparoscopic to open cholecystectomy: an institutional study

Background: Laparoscopic cholecystectomy has become the gold standard treatment for symptomatic gallstones. However, a conversion to open surgery may be required to complete the procedure safely. The aim of this study is to identify the predictive factors of conversion from laparoscopic to open cholecystectomy in elective setting.Methods: A retrospective review of all patients underwent laparoscopic cholecystectomy electively for symptomatic gallstones from January 2016 to December 2017 was performed. Data considered for analysis were: demographic data, preoperative laboratory values of liver function tests, gall bladder wall thickness on ultrasound, preoperative ERCP, indication for surgery, history of acute cholecystitis, presence of intraoperative adhesions and frozen Calot's triangle. Conversion to open cholecystectomy was chosen as the dependent variable for both, univariate and multivariate analysis.Results: 546 patients underwent laparoscopic cholecystectomy. 333 were females (60.9%) and 213 (39.1%) males, with a mean age of 44.6 years. The most common indication for surgery was symptomatic cholelithiasis. Conversion to open cholecystectomy occurred in 48 cases (8.8%) and the most common reason for conversion was inability to define the Calot’s triangle anatomy due to inflammation/adhesions. Univariate and multivariate analyses of various variables demonstrated that male gender, gall bladder wall thickness &gt;5 mm and presence of previous documented acute cholecystitis had statistically significant co-relation with higher rates of conversion (p&lt;0.001).Conclusions: Presence of acute cholecystitis, gall bladder wall thickness &gt;5mm on preoperative ultrasound and male gender were independent predictor factors for conversion from laparoscopic to open cholecystectomy. Such patients should be properly counselled about the increased risk for conversion and should be operated by surgeons experienced in laparoscopic procedures to reduce the rate of conversion and operative complications.

急性虫垂炎における保存的治療困難例の検討

急性虫垂炎における保存的治療困難例の検討

Outcomes of laparoscopic management of acute small bowel obstruction: a 7-year experience of 110 consecutive cases with various etiologies.

Laparoscopic surgery is emerging as an alternative to open surgery for treating acute small bowel obstruction (SBO). While postoperative adhesion is the most frequent etiology, the optimum treatment for all types of SBO needs to be evaluated. A retrospective review was performed of 110 consecutive patients who underwent laparoscopic surgery at our institution between 2009 and 2015. The short-term outcomes included perioperative factors, while the long-term outcome included the recurrence rate. Of the 110 patients, 55 were female. The median age at surgery was 69.5years. Laparoscopic surgery was completed in 91.8%. The median operative time was 82min, median amount of bleeding was 0ml, and median postoperative hospital stay was 8days. Intraoperative major organ injury was seen in 2.7%. The complication rate (Clavien-Dindo≥class II) was 8.2%, and the mortality rate was 3.6%. The recurrence rate was 8.2%. Only dense and matted adhesion was a predictive factor for conversion (OR 30.244). Good short-term outcomes and feasible long-term outcomes were achieved with a laparoscopic approach to treating acute SBO. It was a safe and effective method, especially in patients with isolated bands, simple enteral angulation, and foreign body or tumor, while dense and matted adhesions were still challenging.

Analysis of conversion factors in robotic-assisted rectal cancer surgery

Robotic surgical management of rectal cancer has a series of advantages which might facilitate the surgical approach to the pelvic cavity and reduce conversion rates. The aim of the present study is to identify independent factors for conversion during robotic rectal cancer surgery. A total of 67 patients underwent preoperative CT scan in order to obtain a three-dimensional image of the pelvis, the tumour and prostate. We measured maximum and minimum ilio-iliac, sacral promontory-pubis, coccyx-pubis diameters and maximum lateral axis. Further variables under consideration were age, BMI and use of neoadjuvant therapy. We recorded short-term follow-up outcomes of the resected tumour. The present study included 67 patients (39 males) with an average age of 65.11 ± 10.30 years and a BMI of 27.70 ± 3.97 kg/m(2). Operative procedures included nine abdominoperineal resections and 58 low anterior resections. There were 15 (22.38 %) conversions. Mean operating time was 192.2 ± 42.73 min. Minimum ilio-iliac, maximum ilio-iliac, promontory-pubic and coccyx-pubis diameter as well as maximum lateral axis were 100.38 ± 7.65, 107.10 ± 10.01, 109.97 ± 9.20, 105.61 ± 9.27 and 129.01 ± 9.94 mm, respectively. Mean tumour volume was 37.06 ± 44.08 cc; mean prostate volume was 42.07 ± 17.49 cc. The univariate analysis of the variables showed a correlation between conversion and BMI and minimum ilio-iliac and coccyx-pubis diameters (p = 0.004, 0.047, 0.046). In the multivariate analysis, the only independent predictive factor for conversion was the BMI (p = 0.004).No correlation was found between conversion and sex, age, tumour volume or the rest of pelvic diameters. BMI is an independent factor for conversion in robotic-assisted rectal cancer surgery.

Laparoscopic Cholecystectomy; It’s Complications and Causes of Conversion to Open Cholecystectomy.

Background: The laparoscopic cholecystectomy is the gold standard for treating the symptomatic cholelithiasis. Conversion is sometimes necessary due to finding unexpected pathology,intraoperative complications or unexpected technical errors .&#x0D; Objectives: The aims of this study were to determine the complications and the predictive factors of conversion in patients undergoing laparoscopic cholecystectomy for various indications in elective and acute settings in a general hospital in order to reduce the incidence rates of both , complications and conversion of laparoscopic cholecystectomy to the open technique .&#x0D; Patients and Methods: This is a prospective study included 128 patients [their ages ranged from18 -65 years; the mean =39.60 ± 11.37 SD years].Female patients were 111 (86.7 ) ,male patients were 17 (13.3 % ) . These patients underwent a laparoscopic cholecystectomy in AL-Karama Teaching Hospital / College of Medicine / Wasit University-Iraq,from April 2011 till December 2012. Recorded data were sex, age, indications for laparoscopic cholecystectomy , complications, conversion to the open technique , reasons of conversion, co- morbidity , length of the hospital stay and 30- day mortality.&#x0D; Results: The intraoperative complications were; bleeding from the cystic artery in 9 patients (7.03 %), perforation of the gallbladders in17 patients (13.28% ) and spillage of the stones from cystic duct stump in12 patients( 9.37% ).All these complications were successfully treated laparoscopically.This study has no postoperative complications during follow-up period . Conversion from a laparoscopic cholecystectomy to an open cholecystectomy was performed for 7 patients ( 5.49 % ). The reasons for conversion were ; dense fibrosis of Calot’s triangle in two patients ( 1.56 % ) and one patient(0.78 % ) for each of the following pathologies : cholecystoduodental fistula ,postoperative adhesions , impacted stone in the cystic duct , Mirrizzi’s syndrome and incidental CBD stone.The intaoperative findings and postoperative histopathologic diagnoses were: 114 patients( 89.1 % ) with chronic calculous cholecystitis, 5 patients ( 3.9 % ) with acute calculous cholecystitis, 5 patients( 3,9 % ) with empyema of the gall bladder, 4 patients ( 3.1 % ) with mucocele of the gall bladder .There was no mortality in this study . &#x0D; Conclusions: In this study,there were simple complications being laparoscopically treated .Male gender, age older than 50 years that were associated with dense fibrosis of Calot’s triangle , postoperative upper abdominal adhesions,cholecystoduodenal fistula Mirrizi’syndrome ,impaced stones in the cystic duct and incidental CBD stone were the main factors of conversion .

Risk of multiple sclerosis following clinically isolated syndrome: a 4-year prospective study

The aim of the study was to estimate the rate of conversion from clinically isolated syndrome (CIS) to multiple sclerosis (MS) and to investigate variables predicting conversion in a cohort of patients presenting with symptoms suggestive of MS. Patients with a first symptom suggestive of MS in the preceding 6 months and exclusion of other diseases were enrolled in an observational prospective study from December 2004 through June 2007. Conversion from CIS to MS according to both McDonald and Clinically Defined Multiple Sclerosis (CDMS) criteria was prospectively recorded until March 2010. The multivariate Cox proportional hazard model was used to assess the best predictive factors of conversion from CIS to MS. Among 168 patients included in the analysis, 122 converted to MS according to McDonald criteria whereas 81 converted to MS according to CDMS criteria. The 2-year probability of conversion was 57% for McDonald Criteria and 36% for CDMS criteria. Variables at enrolment significantly associated with conversion according to McDonald criteria were age and positivity for Barkhof criteria, and according to Poser's CDMS criteria, age, positivity for Barkhof criteria and no disease modifying therapy. In this large prospective cohort study the conversion rate from CIS to MS in patients presenting with recent symptoms suggestive of MS was within the range of previous observational studies and lower than that reported in the placebo arm of randomized trials. We confirm the prognostic value of MRI in addition to the previous experimental data on the protective role of disease-modifying therapies.

Selecting patients during the “learning curve” of endoscopic Totally Extraperitoneal (TEP) hernia repair

Totally Extraperitoneal (TEP) hernia surgery is associated with little postoperative pain and a fast recovery, but is a technically demanding operative procedure. Apart from the surgeon's expertise, patient characteristics and hernia-related variations may also affect the operative time and outcome. Patient-related factors predictive of perioperative complications, conversion to open anterior repair, and operative time were studied in a cohort of consecutive patients undergoing TEP hernia repair from 2005 to 2009. A total of 3,432 patients underwent TEP. The mean operative time was 26 min (SD ± 10.9), TEP was converted into an open anterior approach in 26 patients (0.8 %), and perioperative complications were observed in 55 (1.6 %) patients. Multivariable regression analysis showed that a history of abdominal surgery (OR 1.76, 95 per cent confidence interval 1.01-3.06; p = 0.05), and the presence of a scrotal (OR 5.31, 1.20-23.43; p = 0.03) or bilateral hernia (OR 2.25, 1.25-4.06; p = 0.01) were independent predictive factors of perioperative complications. Female gender (OR 5.30. 1.52-18.45; p = 0.01), a history of abdominal surgery (OR 3.96, 1.72- 9.12; p = 0.001), and the presence of a scrotal hernia (OR 34.84, 10.42-116.51, p < 0.001) were predictive factors for conversion. A BMI ≥ 25 (effect size (ES) 1.78, 95 % confidence interval 1.09-2.47; p < 0.001) and the presence of a scrotal (ES 5.81, 1.93-9.68; p = 0.003), indirect (ES 2.78, 2.05- 3.50, p < 0.001) or bilateral hernia (ES 10.19, 9.20-11.08; p < 0.001) were associated with a longer operative time. Certain patient characteristics are, even in experienced TEP surgeons, associated with an increased risk of conversion and complications and a longer operative time. For the surgeon gaining experience with TEP, it seems advisable to select relatively young and slender male patients with a unilateral (non-scrotal) hernia and no previous abdominal surgery to enhance patient safety and 'surgeon comfort'.

Assessing the value of spinal cord lesions in predicting development of multiple sclerosis in patients with clinically isolated syndromes

The purpose of this study was to determine the value of spinal cord lesions as a predictive factor for conversion in clinically isolated syndrome (CIS) patients. Patients with CIS and without immunomodulatory treatment were prospectively included. Age at onset, sex, clinical syndrome at onset, oligoclonal bands, and presence, number and location of lesions on brain and spinal MRI were analyzed. Conversion to multiple sclerosis (MS) was the primary endpoint. Cox regression was used to compare outcomes between groups. A total of 75 patients were included: 53 (71%) women, mean age at onset 32.7 years (SD ± 7.5), mean follow-up time 72.5 months (SD ± 9; range 17-104 months). There were 11 (14.6%) patients with one focal spinal cord lesion, while 13 (17%) patients had two or more spinal cord lesions at the first scan during the onset of the disease. Of the 23 patients (30.6%) who converted to clinically definite MS (CDMS), 2 had a normal spinal cord MRI, 8 patients had one spinal cord lesion, and 13 had more than one lesion on MRI (p < 0.001). In multivariable analyses, one focal spinal cord lesion was significantly associated with increased risk of conversion to MS (p = 0.01, HR 3.5, CI 95% 2.1-6.9), while the presence of two or more focal spinal cord lesions was independently associated with a higher risk of conversion to MS (p < 0.001, HR 5.9, CI 95% 3.2-10.8). CIS patients with an abnormal baseline spinal cord MRI have a higher risk for developing clinically definite MS, independent of brain lesions as well as the presence of cerebrospinal fluid oligoclonal banding (OSF-OB) .

1520 INTRAOPERATIVE CONVERSION FROM PARTIAL TO RADICAL NEPHRECTOMY AT A SINGLE INSTITUTION FROM 2003 TO 2008

You have accessJournal of UrologyKidney Cancer: Localized1 Apr 20111520 INTRAOPERATIVE CONVERSION FROM PARTIAL TO RADICAL NEPHRECTOMY AT A SINGLE INSTITUTION FROM 2003 TO 2008 David Galvin, Caroline Savage, Ari Adamy, Mathew Kaag, Frank O'Brien, Kallingal George, and Paul Russo David GalvinDavid Galvin New York, NY More articles by this author , Caroline SavageCaroline Savage New York, NY More articles by this author , Ari AdamyAri Adamy New York, NY More articles by this author , Mathew KaagMathew Kaag New York, NY More articles by this author , Frank O'BrienFrank O'Brien New York, NY More articles by this author , Kallingal GeorgeKallingal George New York, NY More articles by this author , and Paul RussoPaul Russo New York, NY More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1513AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Little information on conversion from partial to radical nephrectomy exists. We assessed the intraoperative reasons and predictive factors for conversion in a contemporary series of patients undergoing PN. METHODS We identified all patients at our institution undergoing either open or laparoscopic PN who were converted to RN between 2003 and 2008. Renal function was assessed by glomerular filtration rate using the MDRD equation. Logistic regression analysis was used to determine whether tumor location, tumor size, body mass index, ASA score, age or gender was associated with risk of conversion. RESULTS The rate of conversion to RN was 6% (61 of 1,029 patients). In the OPN group 59 of 865 were converted (7% [95% CI: 5%, 9%]), and in the LPN group 2 of 164 (1.2% [95% CI: 0.01%, 4%]). The rate of conversion fell over time (figure 1). The most common reasons for conversion were invasion of hilar structures, size discrepancy and insufficient residual kidney. Converted patients were more likely to have larger tumors (OR per 1 cm increase 1.41; 95% CI: 1.24, 1.59), central location (OR for central vs peripheral location 7.74; 95% CI: 3.98, 15), lower preoperative GFR (OR per 10 mL/min/1.73m2 0.78; 95% CI: 0.67, 0.91) and present with symptoms (OR for any symptoms versus none 2.78; 95% CI: 1.54, 5.04) than those not converted. Median postoperative GFR was 46 ml/min/1.73m2 for the converted group and 61 ml/min/1.73m2 for those not converted (figure 2). CONCLUSIONS Conversion to RN was uncommon in patients undergoing PN in this series. Increasing tumor size, central location, lower preoperative GFR and symptoms at presentation were associated with increased risk of conversion, which increases the likelihood of postoperative CKD. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byTsivian M, Joyce D, Packiam V, Lohse C, Boorjian S, Potretzke T, Chow G, Leibovich B, Sharma V and Thompson R (2022) Unplanned Conversion From Partial to Radical Nephrectomy: An Analysis of Incidence, Etiology, and Risk FactorsJournal of Urology, VOL. 208, NO. 5, (960-968), Online publication date: 1-Nov-2022. Volume 185Issue 4SApril 2011Page: e609-e610 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information David Galvin New York, NY More articles by this author Caroline Savage New York, NY More articles by this author Ari Adamy New York, NY More articles by this author Mathew Kaag New York, NY More articles by this author Frank O'Brien New York, NY More articles by this author Kallingal George New York, NY More articles by this author Paul Russo New York, NY More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Intraoperative Conversion From Partial to Radical Nephrectomy at a Single Institution From 2003 to 2008

Little information exists on conversion from partial to radical nephrectomy. We assessed the intraoperative reasons and predictive factors for conversion in a contemporary series of patients undergoing partial nephrectomy. We identified all patients at our institution who underwent open or laparoscopic partial nephrectomy with conversion to radical nephrectomy between 2003 and 2008. Renal function was assessed by the glomerular filtration rate using the modification of diet in renal disease equation. We used logistic regression analysis to determine whether tumor site, tumor size, body mass index, American Society of Anesthesiologists score, age or gender was associated with the conversion risk. The rate of conversion to radical nephrectomy was 6% (61 of 1,029 patients). In the open partial nephrectomy group 59 of 865 cases (7%, 95% CI 5-9) and in the laparoscopic partial nephrectomy group 2 of 164 (1.2%, 95% CI 0.01-4) were converted. The most common reasons for conversion were invasion of hilar structures, size discrepancy and insufficient residual kidney. Patients with conversion were more likely to have larger tumors (per 1 cm increase OR 1.41, 95% CI 1.24-1.59), a central site (central vs peripheral OR 7.74, 95% CI 3.98-15) and a lower preoperative glomerular filtration rate (per 10 ml/minute/1.73 m(2) OR 0.78, 95% CI 0.67-0.91), and present with symptoms (any vs none OR 2.78, 95% CI 1.54-5.04) than those without conversion. The median postoperative glomerular filtration rate was 46 vs 61 ml/minute/1.73 m(2) in patients with vs without conversion. Conversion to radical nephrectomy was rare in patients undergoing partial nephrectomy in this series. Increasing tumor size, central site, lower preoperative glomerular filtration rate and symptoms at presentation were associated with an increased risk of conversion, which increases the likelihood of chronic kidney disease postoperatively.

Conversion after laparoscopic cholecystectomy in England

We read with great interest the article Conversion After Laparoscopic Cholecystectomy in England published in the Surgical Endoscopy [1]. We appreciate the efforts of the authors to explore the causes for conversion of laparoscopic cholecystectomy (LC) in England. We think the following points are complementary to the educational value of the study: 1. The two parameters for assessing difficult LC are conversion and the iatrogenic injuries. The article assessed some of the factors associated with conversion but did not indicate what types of injuries were encountered in the study group. We are very interested in knowing how many bile duct injuries and other visceral injuries were reported in this national study. In the United States, about 600,000 cases of LC are managed every year as well as approximately 1,800 to 3,600 bile duct injuries per year (incidence, 0.3‐0.6%) [2, 3]. 2. The article confirmed several predictive factors for conversion. However, other important factors were not mentioned including upper abdominal adhesions, obesity, liver cirrhosis, cholecysto-enteric fistula, large liver and gallbladder, abnormal anatomy due to Mirizzi syndrome, choledochal cyst, and cholangiocarcinoma. The significance of these parameters was confirmed in the literature [4]. Awareness of these by the surgical community that performs LC is therefore crucial to the reduction of the conversion rate to a minimum. We appreciate a kind response from the authors.

Predictive Factors For Conversion Of Laparoscopic Cholecystectomy To Open Procedure

Background and objective: Laparoscopic cholecystectomy is the gold stander surgery for gallbladder diseases, especially symptomatic gall stone disease. to identify the factors that causes the conversion of planed laparoscopic cholecystectomy to an open procedure. Identifying these predictive factors will predict the conversion rate and eventually will help the surgeon, the patient and the hospital in planning the surgery. Methods: Retrospective study. Between October 2003 and December 2004 hundred and fifty patients with symptomatic gallstone underwent laparoscopic cholecystectomy in Department of Surgery, Sulaimaniyah Teaching Hospital Results: ages of the patients were between 11-70 years with a mean of 40, female to male were 5/1, and in 47% the symptoms were present for more than two years. Conversion incidence was 8.7. Conclusion: The predictive factors for conversion in our study accordingly were duration of the symptoms, abnormal intra-abdominal findings, concurrent illnesses, and intra-operative complications.