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首页> 外文期刊>Surgical Endoscopy >Conversion rates in laparoscopic colorectal surgery: a predictive model with, 1253 patients.
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Conversion rates in laparoscopic colorectal surgery: a predictive model with, 1253 patients.

机译：腹腔镜结直肠癌手术的转化率：1253例患者的预测模型。

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BACKGROUND: This study aimed all develop a mathematical model for predicting the conversion rate for patients undergoing laparoscopic colorectal surgery. METHOD: This descriptive single-center study used routinely collected clinical data from 1,253 patients undergoing laparoscopic surgery between November 1991 and April 2003. A two-level hierarchical regression model was used to identify patient, surgeon, and procedure-related factors associated with conversion of laparoscopic to open surgery. The model was internally validated and tested using measures of discrimination and calibration. Exclusion criteria for laparoscopic colectomy included a body mass greater than 50, lesion diameter exceeding 15 cm, and multiple prior major laparotomies (exclusive of appendectomy, hysterectomy, and cholecystectomy). RESULTS: The average conversion rate for the study population was 10.0% (95% confidence interval [CI], 8.3-11.7%). The independent predictors of conversion of laparoscopic to open surgery were the body mass index (odds ratio [OR], 2.1 per 10 Americans Society of Anesthesiology units increase), (ASA) grade 3 or 4, 1 or 2 (OR, 3.2, 5.8), type of resection (low rectal, left colorectal, right colonic vs small/other bowel procedures; OR, 8.82, 4.76, 2.98), presence of intraoperative abscess (OR, 3.60) or fistula (OR, 4.73), and surgeon seniority (junior vs senior staff OR, 1.56). The model offered adequate discrimination (area under receiver operator characteristic curve, 0.74) and excellent agreement (p = 0.384) between observed and model-predicted conversion rates (range of calibration, 3-32% conversion rate). CONCLUSIONS: Laparoscopic conversion rates are dependent on a multitude of factors that require appropriate adjustment for case mix before comparisons are made between or within centers. The Cleveland Clinic Foundation (CCF) laparoscopic conversion rate model is a simple additive score that can be used in everyday practice to evaluate outcomes for laparoscopic colorectal surgery.
机译：背景：这项研究的目的是为预测腹腔镜结直肠癌手术患者的转化率建立一个数学模型。方法：该描述性单中心研究使用常规方法收集了1991年11月至2003年4月间接受腹腔镜手术的1,253例患者的临床数据。采用两级分层回归模型来确定与患者，手术医生和与手术相关的因素腹腔镜开腹手术。该模型在内部进行了验证，并使用区分和校准的方法进行了测试。腹腔镜结肠切除术的排除标准包括体重大于50，病变直径超过15厘米，以及多次先前的主要腹腔镜手术（不包括阑尾切除术，子宫切除术和胆囊切除术）。结果：研究人群的平均转化率为10.0％（95％置信区间[CI]，8.3-11.7％）。腹腔镜手术转为开腹手术的独立预测指标是体重指数（比值比[OR]，每10美国人麻醉学会会增加2.1），（ASA）3或4、1或2级（OR，3.2、5.8） ），切除类型（低位直肠，左结直肠，右结肠vs小肠/其他肠手术;或，8.82、4.76、2.98），术中脓肿（OR，3.60）或瘘管（OR，4.73）的存在以及外科医生的资历（初级vs高级员工，或1.56）。该模型提供了足够的辨别力（在接收器操作员特征曲线下的面积，0.74）以及观测到的和预测的转换率之间的极佳一致性（p = 0.384）（校准范围，3-32％转换率）。结论：腹腔镜转换率取决于多种因素，在中心之间或中心之间进行比较之前，需要对病例组合进行适当的调整。克利夫兰诊所基金会（CCF）腹腔镜转换率模型是一个简单的累加得分，可以在日常实践中用于评估腹腔镜结直肠癌手术的结局。

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