Predictors and outcomes of converted minimally invasive pancreaticoduodenectomy: a propensity score matched analysis

Caitlin A. Hester, Ibrahim Nassour, Alana Christie, Mathew M. Augustine, John C. Mansour, Patricio M. Polanco, Matthew R. Porembka, Thomas H. Shoultz, Sam C. Wang, Adam C. Yopp, Herbert J. Zeh, Rebecca M Minter

Research output: Contribution to journalArticle

Abstract

Background: Data-driven patient selection guidelines are not available to optimize outcomes in minimally invasive pancreaticoduodenectomy (MIPD). We aimed to define risk factors associated with conversion from MIPD to open PD and to determine the impact of conversion on post-operative outcomes. Methods: We conducted a retrospective review of MIPD using NSQIP from 2014 to 2015. Propensity score was used to match patients who underwent completed MIPD to converted MIPD. Results: 467 patients were included: 375 (80.3%) MIPD and 92 (19.7%) converted. Converted patients were more often male (64% vs. 52%, p = 0.030), had higher rates of dyspnea (10% vs. 3%, p = 0.009), underwent more vascular (44% vs. 14%, p < 0.001) or multivisceral resection (19% vs. 6%, p = 0.0005), and were more likely attempted laparoscopically compared to robotically (76% vs. 51%, p < 0.001). Robotic approach was independently associated with reduced risk of conversion (OR 0.40, 95% CI 0.23–0.69), while male gender (OR 1.70, 95% CI 1.02–2.84), history of dyspnea (OR 3.85, 95% CI 1.49–9.96), vascular resection (OR 4.32, 95% CI 2.53–7.37), and multivisceral resection (OR 2.18, 95% CI 1.05–4.52) were associated with increased risk. Major complications were more common in converted patients (68% vs. 37%, p < 0.001). Converted patients had increased odds of non-home discharge (OR 3.25, 95% CI 1.06–9.97) and an associated increased length of stay of 3 days (95% CI 0.1–6.7). Conclusion: Patients with a history of dyspnea or tumors requiring vascular or multivisceral resection were at increased risk of conversion, and the robotic platform was associated with a lower rate of conversion. Conversion was independently associated with increased overall complications, increased length of stay, and non-home discharge.

Original languageEnglish (US)
JournalSurgical Endoscopy
DOIs
StatePublished - Jan 1 2019

Fingerprint

Propensity Score
Pancreaticoduodenectomy
Dyspnea
Blood Vessels
Robotics
Length of Stay
Patient Selection
Guidelines
Neoplasms

Keywords

  • Converted
  • Minimally invasive
  • Outcomes
  • Pancreaticoduodenectomy
  • Predictors

ASJC Scopus subject areas

  • Surgery

Cite this

@article{1d50b0a56a674c74b611c4ff011d2b6e,
title = "Predictors and outcomes of converted minimally invasive pancreaticoduodenectomy: a propensity score matched analysis",
abstract = "Background: Data-driven patient selection guidelines are not available to optimize outcomes in minimally invasive pancreaticoduodenectomy (MIPD). We aimed to define risk factors associated with conversion from MIPD to open PD and to determine the impact of conversion on post-operative outcomes. Methods: We conducted a retrospective review of MIPD using NSQIP from 2014 to 2015. Propensity score was used to match patients who underwent completed MIPD to converted MIPD. Results: 467 patients were included: 375 (80.3{\%}) MIPD and 92 (19.7{\%}) converted. Converted patients were more often male (64{\%} vs. 52{\%}, p = 0.030), had higher rates of dyspnea (10{\%} vs. 3{\%}, p = 0.009), underwent more vascular (44{\%} vs. 14{\%}, p < 0.001) or multivisceral resection (19{\%} vs. 6{\%}, p = 0.0005), and were more likely attempted laparoscopically compared to robotically (76{\%} vs. 51{\%}, p < 0.001). Robotic approach was independently associated with reduced risk of conversion (OR 0.40, 95{\%} CI 0.23–0.69), while male gender (OR 1.70, 95{\%} CI 1.02–2.84), history of dyspnea (OR 3.85, 95{\%} CI 1.49–9.96), vascular resection (OR 4.32, 95{\%} CI 2.53–7.37), and multivisceral resection (OR 2.18, 95{\%} CI 1.05–4.52) were associated with increased risk. Major complications were more common in converted patients (68{\%} vs. 37{\%}, p < 0.001). Converted patients had increased odds of non-home discharge (OR 3.25, 95{\%} CI 1.06–9.97) and an associated increased length of stay of 3 days (95{\%} CI 0.1–6.7). Conclusion: Patients with a history of dyspnea or tumors requiring vascular or multivisceral resection were at increased risk of conversion, and the robotic platform was associated with a lower rate of conversion. Conversion was independently associated with increased overall complications, increased length of stay, and non-home discharge.",
keywords = "Converted, Minimally invasive, Outcomes, Pancreaticoduodenectomy, Predictors",
author = "Hester, {Caitlin A.} and Ibrahim Nassour and Alana Christie and Augustine, {Mathew M.} and Mansour, {John C.} and Polanco, {Patricio M.} and Porembka, {Matthew R.} and Shoultz, {Thomas H.} and Wang, {Sam C.} and Yopp, {Adam C.} and Zeh, {Herbert J.} and Minter, {Rebecca M}",
year = "2019",
month = "1",
day = "1",
doi = "10.1007/s00464-019-06792-0",
language = "English (US)",
journal = "Surgical Endoscopy and Other Interventional Techniques",
issn = "0930-2794",
publisher = "Springer New York",

}

TY - JOUR

T1 - Predictors and outcomes of converted minimally invasive pancreaticoduodenectomy

T2 - a propensity score matched analysis

AU - Hester, Caitlin A.

AU - Nassour, Ibrahim

AU - Christie, Alana

AU - Augustine, Mathew M.

AU - Mansour, John C.

AU - Polanco, Patricio M.

AU - Porembka, Matthew R.

AU - Shoultz, Thomas H.

AU - Wang, Sam C.

AU - Yopp, Adam C.

AU - Zeh, Herbert J.

AU - Minter, Rebecca M

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: Data-driven patient selection guidelines are not available to optimize outcomes in minimally invasive pancreaticoduodenectomy (MIPD). We aimed to define risk factors associated with conversion from MIPD to open PD and to determine the impact of conversion on post-operative outcomes. Methods: We conducted a retrospective review of MIPD using NSQIP from 2014 to 2015. Propensity score was used to match patients who underwent completed MIPD to converted MIPD. Results: 467 patients were included: 375 (80.3%) MIPD and 92 (19.7%) converted. Converted patients were more often male (64% vs. 52%, p = 0.030), had higher rates of dyspnea (10% vs. 3%, p = 0.009), underwent more vascular (44% vs. 14%, p < 0.001) or multivisceral resection (19% vs. 6%, p = 0.0005), and were more likely attempted laparoscopically compared to robotically (76% vs. 51%, p < 0.001). Robotic approach was independently associated with reduced risk of conversion (OR 0.40, 95% CI 0.23–0.69), while male gender (OR 1.70, 95% CI 1.02–2.84), history of dyspnea (OR 3.85, 95% CI 1.49–9.96), vascular resection (OR 4.32, 95% CI 2.53–7.37), and multivisceral resection (OR 2.18, 95% CI 1.05–4.52) were associated with increased risk. Major complications were more common in converted patients (68% vs. 37%, p < 0.001). Converted patients had increased odds of non-home discharge (OR 3.25, 95% CI 1.06–9.97) and an associated increased length of stay of 3 days (95% CI 0.1–6.7). Conclusion: Patients with a history of dyspnea or tumors requiring vascular or multivisceral resection were at increased risk of conversion, and the robotic platform was associated with a lower rate of conversion. Conversion was independently associated with increased overall complications, increased length of stay, and non-home discharge.

AB - Background: Data-driven patient selection guidelines are not available to optimize outcomes in minimally invasive pancreaticoduodenectomy (MIPD). We aimed to define risk factors associated with conversion from MIPD to open PD and to determine the impact of conversion on post-operative outcomes. Methods: We conducted a retrospective review of MIPD using NSQIP from 2014 to 2015. Propensity score was used to match patients who underwent completed MIPD to converted MIPD. Results: 467 patients were included: 375 (80.3%) MIPD and 92 (19.7%) converted. Converted patients were more often male (64% vs. 52%, p = 0.030), had higher rates of dyspnea (10% vs. 3%, p = 0.009), underwent more vascular (44% vs. 14%, p < 0.001) or multivisceral resection (19% vs. 6%, p = 0.0005), and were more likely attempted laparoscopically compared to robotically (76% vs. 51%, p < 0.001). Robotic approach was independently associated with reduced risk of conversion (OR 0.40, 95% CI 0.23–0.69), while male gender (OR 1.70, 95% CI 1.02–2.84), history of dyspnea (OR 3.85, 95% CI 1.49–9.96), vascular resection (OR 4.32, 95% CI 2.53–7.37), and multivisceral resection (OR 2.18, 95% CI 1.05–4.52) were associated with increased risk. Major complications were more common in converted patients (68% vs. 37%, p < 0.001). Converted patients had increased odds of non-home discharge (OR 3.25, 95% CI 1.06–9.97) and an associated increased length of stay of 3 days (95% CI 0.1–6.7). Conclusion: Patients with a history of dyspnea or tumors requiring vascular or multivisceral resection were at increased risk of conversion, and the robotic platform was associated with a lower rate of conversion. Conversion was independently associated with increased overall complications, increased length of stay, and non-home discharge.

KW - Converted

KW - Minimally invasive

KW - Outcomes

KW - Pancreaticoduodenectomy

KW - Predictors

UR - http://www.scopus.com/inward/record.url?scp=85064817689&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85064817689&partnerID=8YFLogxK

U2 - 10.1007/s00464-019-06792-0

DO - 10.1007/s00464-019-06792-0

M3 - Article

C2 - 31016458

AN - SCOPUS:85064817689

JO - Surgical Endoscopy and Other Interventional Techniques

JF - Surgical Endoscopy and Other Interventional Techniques

SN - 0930-2794

ER -