SSAT - THE IMPACT OF UNPLANNED CONVERSION TO AN OPEN PROCEDURE DURING MINIMALLY INVASIVE PANCREATECTOMY

Back to 2017 Posters

THE IMPACT OF UNPLANNED CONVERSION TO AN OPEN PROCEDURE DURING MINIMALLY INVASIVE PANCREATECTOMY
Zachary E. Stiles^*, Paxton Dickson, Evan Glazer, Jeremiah Deneve, Stephen W. Behrman
General Surgery, University of Tennessee Health Science Center (UTHSC), Memphis, TN

Introduction/Objective: Minimally invasive pancreatectomy (MIP) is being utilized with increasing frequency. Using a national database, we sought to examine short-term outcomes of those undergoing unplanned conversion to an open procedure and determine factors predictive of failed MIP.

Methods: 2014-2015 ACS-NSQIP datasets were examined. Based on CPT code, proximal and distal pancreatectomies were selected and grouped by modality. Successful MIP was compared to unplanned conversion to open procedure. Outcomes and 30-day mortality were compared. Patient specific variables were examined. Statistical analysis was performed with students t-test and the chi-square for continuous and categorical variables, respectively.

Results: 266 (20.6%) of 1291 distal MIP were unsuccessful and experienced unplanned conversion to open procedure. Unplanned conversion was associated with significantly greater morbidity, including higher rates of delayed gastric emptying (6.8 vs 1.4%), superficial SSI (3.8 vs 1.4%), organ space SSI (12.4 vs 6.4%), unplanned re-intubation (3.8 vs 1.0%), cardiac arrest (1.9 vs 0.2%), MI (1.5 vs 0.3%), septic shock (1.9 vs 0.5%), and perioperative bleeding (22.2 vs 3.3%) (all p<0.05). Unplanned conversion was associated with greater LOS (7.6 d vs 5.3 d, p <0.0001) and unplanned readmission (20.7 vs 14.6%, p 0.0186). Greater 30-day mortality was seen with unplanned conversion (2.6 vs 0.2%, p = 0.0004). Patient specific variables associated with unplanned conversion include male sex (OR 1.6, 95% CI 1.2 - 2.1), resection for malignancy (OR 1.5, 95% CI 1.1 - 1.9), need for vascular resection (OR 2.2, 95% CI 1.3 - 3.6), tobacco use (OR 2.0, 95% CI 1.5 - 2.8), and >10% weight loss (OR 2.1, 95% CI 1.2 - 3.9).

Of 400 proximal MIP, 102 (25.5%) experienced unplanned conversion. Again, a trend toward more complications was seen. Significantly higher rates of pancreatic fistula (28.4 vs 17.8%), pneumonia (6.9 vs 1.3%), respiratory failure (6.9 vs 1.3%), sepsis (13.7 vs 5.0%), and perioperative bleeding (43.1 vs 9.4%) were seen compared to those who underwent successful MIP (all p<0.05). Unplanned conversion was associated with percutaneous drainage (30.4% vs 11.7, p<0.0001) and prolonged LOS (13.8 d vs 9.5 d, p<0.0001). Higher 30-day mortality was seen but failed to reach statistical significance (4.9 vs 2.3%, p=0.1925). Patient specific factors associated with unplanned conversion include male gender (OR 1.6, 95% CI 1.0 - 2.6), vascular resection (OR 6.0, 95% CI 3.4 - 10.5), disseminated cancer (OR 10.9, 95% CI 2.2 - 53.4), and chronic steroid use (OR 3.6, 95% CI 1.2 - 10.9).

Conclusion: In this national database, unplanned conversion to an open procedure during MIP is associated with greater morbidity and mortality. This investigation identified several factors that should be carefully considered when selecting patients for MIP.

Back to 2017 Posters