Incorporating low haemoglobin into a risk prediction model for conversion in minimally invasive gynaecologic oncology surgeries
Background 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 gyna...
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| Format: | Article |
| Language: | English |
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Taylor & Francis Group
2024-12-01
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| Series: | Journal of Obstetrics and Gynaecology |
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| Online Access: | https://www.tandfonline.com/doi/10.1080/01443615.2024.2349960 |
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| author | Kevin H. Nguyen Hyundeok Joo Solmaz Manuel Lee-may Chen Lee-lynn Chen |
| author_facet | Kevin H. Nguyen Hyundeok Joo Solmaz Manuel Lee-may Chen Lee-lynn Chen |
| author_sort | Kevin H. Nguyen |
| collection | DOAJ |
| description | Background 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.Methods 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.Results 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%).Conclusions 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. |
| format | Article |
| id | doaj-art-89a69f1929574d398be93f7189ec6fdd |
| institution | Kabale University |
| issn | 0144-3615 1364-6893 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | Taylor & Francis Group |
| record_format | Article |
| series | Journal of Obstetrics and Gynaecology |
| spelling | doaj-art-89a69f1929574d398be93f7189ec6fdd2025-01-09T12:13:17ZengTaylor & Francis GroupJournal of Obstetrics and Gynaecology0144-36151364-68932024-12-0144110.1080/01443615.2024.2349960Incorporating low haemoglobin into a risk prediction model for conversion in minimally invasive gynaecologic oncology surgeriesKevin H. Nguyen0Hyundeok Joo1Solmaz Manuel2Lee-may Chen3Lee-lynn Chen4Department of Anesthesiology, Perioperative and Pain Medicine, Stanford Medicine, Palo Alto, CA, USADepartment of Anesthesia and Perioperative Care, University of California, San Francisco, CA, USADepartment of Anesthesia and Perioperative Care, University of California, San Francisco, CA, USADepartment of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA, USADepartment of Anesthesia and Perioperative Care, University of California, San Francisco, CA, USABackground 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.Methods 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.Results 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%).Conclusions 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.https://www.tandfonline.com/doi/10.1080/01443615.2024.2349960Open conversionminimally invasive surgerypreoperative haemoglobinrisk prediction modelgynaecologic oncology |
| spellingShingle | Kevin H. Nguyen Hyundeok Joo Solmaz Manuel Lee-may Chen Lee-lynn Chen Incorporating low haemoglobin into a risk prediction model for conversion in minimally invasive gynaecologic oncology surgeries Journal of Obstetrics and Gynaecology Open conversion minimally invasive surgery preoperative haemoglobin risk prediction model gynaecologic oncology |
| title | Incorporating low haemoglobin into a risk prediction model for conversion in minimally invasive gynaecologic oncology surgeries |
| title_full | Incorporating low haemoglobin into a risk prediction model for conversion in minimally invasive gynaecologic oncology surgeries |
| title_fullStr | Incorporating low haemoglobin into a risk prediction model for conversion in minimally invasive gynaecologic oncology surgeries |
| title_full_unstemmed | Incorporating low haemoglobin into a risk prediction model for conversion in minimally invasive gynaecologic oncology surgeries |
| title_short | Incorporating low haemoglobin into a risk prediction model for conversion in minimally invasive gynaecologic oncology surgeries |
| title_sort | incorporating low haemoglobin into a risk prediction model for conversion in minimally invasive gynaecologic oncology surgeries |
| topic | Open conversion minimally invasive surgery preoperative haemoglobin risk prediction model gynaecologic oncology |
| url | https://www.tandfonline.com/doi/10.1080/01443615.2024.2349960 |
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