What are Risk Factors for conversion of minimally invasive gynaecologic oncology surgeries to Laparotomy?

Gynaecologic malignancies contribute significantly to morbidity and mortality with more than half of the cost is associated with hospital stays for diagnosis and treatment. Recent study aimed to identify novel risk factors for conversion from minimally invasive to open surgeries for gynecologic oncology operations. The researchers conducted a retrospective cohort study of 1,356 patients who underwent surgeries for gynecologic masses or malignancies between 2015-2020 at a single academic medical center. The key findings of the study were: 1. Overall conversion rate from minimally invasive to open surgery was 6.1% (43/704 cases). 2. Patients who required conversion had significantly lower preoperative hemoglobin levels compared to minimally invasive and open surgery cases (11.6 ± 1.9 vs 12.8 ± 1.5 vs 11.8 ± 1.9 g/dL, p<.001). 3. Patients with preoperative hemoglobin <10 g/dL had an adjusted odds ratio of 3.94 for conversion, while patients with BMI ≥30 kg/m2 had an adjusted odds ratio of 2.86 for conversion. 4. A risk prediction model incorporating age >50 years, BMI ≥30 kg/m2, ASA status >2, and preoperative hemoglobin <10 g/dL had an AUROC of 0.71, indicating good discriminatory ability. Patients with 2 or more risk factors had a 12% conversion rate.

Novel Findings

The novel finding of lower preoperative hemoglobin as a significant risk factor for conversion provides important insights. Lower hemoglobin may signal greater disease burden and extent of adhesions, leading to increased conversion risk. Incorporating this variable into a risk prediction model can help surgical teams better anticipate conversion, allowing for improved preoperative planning and patient counseling. This can ultimately improve outcomes for patients undergoing minimally invasive gynecologic oncology procedures.

Key Points

Here are the 6 key points from the research paper: 1. The overall conversion rate from minimally invasive to open surgery was 6.1% (43/704 cases). 2. Patients who required conversion had significantly lower preoperative hemoglobin levels compared to minimally invasive and open surgery cases (11.6 ± 1.9 vs 12.8 ± 1.5 vs 11.8 ± 1.9 g/dL, p<.001). 3. Patients with preoperative hemoglobin <10 g/dL had an adjusted odds ratio of 3.94 for conversion, while patients with BMI ≥30 kg/m2 had an adjusted odds ratio of 2.86 for conversion. 4. A risk prediction model incorporating age >50 years, BMI ≥30 kg/m2, ASA status >2, and preoperative hemoglobin <10 g/dL had an AUROC of 0.71, indicating good discriminatory ability. Patients with 2 or more risk factors had a 12% conversion rate. 5. The novel finding of lower preoperative hemoglobin as a significant risk factor for conversion provides important insights, as lower hemoglobin may signal greater disease burden and extent of adhesions, leading to increased conversion risk. 6. Incorporating the preoperative hemoglobin variable into a risk prediction model can help surgical teams better anticipate conversion, allowing for improved preoperative planning and patient counseling, ultimately improving outcomes for patients undergoing minimally invasive gynecologic oncology procedures.

Reference –

Kevin H. Nguyen, Hyundeok Joo, Solmaz Manuel, Lee-may Chen & Lee- lynn Chen (2024) Incorporating low haemoglobin into a risk prediction model for conversion in minimally invasive gynaecologic oncology surgeries, Journal of Obstetrics and Gynaecology, 44:1, 2349960, DOI: 10.1080/01443615.2024.2349960