KEY TAKEAWAYS
- The study aimed to find new risk factors for switching from minimally invasive to open surgery in gynecologic oncology.
- The results revealed low preop hemoglobin as a new risk factor for converting minimally invasive to open gynecologic surgeries.
A common complication in laparoscopic management of gynecological cancer is the need for intraoperative conversion to laparotomy.
Kevin H Nguyen and the team aimed to identify new patient risk factors for conversion from minimally invasive to open surgeries in gynecologic oncology operations.
About 1356 patients aged ≥18 who underwent surgeries for gynecologic masses or malignancies at a single academic medical center between February 2015 and May 2020 were analyzed. Multivariable logistic regression assessed the impact of older age, higher body mass index (BMI), higher American Society of Anesthesiologists (ASA) physical status, and lower preoperative (Preop) hemoglobin on the likelihood of converting from minimally invasive to open surgery. Receiver operating characteristic (ROC) curve analysis evaluated the discriminatory ability of a risk prediction model for conversion.
The results revealed that among 704 planned minimally invasive surgeries, the overall conversion rate was 6.1% (43/704). Preop hemoglobin levels were significantly lower in 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 hemoglobin <10 g/dL had an adjusted odds ratio (OR) of 3.94 (CI: 1.65-9.41, P= .002) for conversion, while those with BMI ≥30 kg/m² had an adjusted OR of 2.86 (CI: 1.50-5.46, P= .001).
The ROC curve analysis, incorporating predictive variables of age >50 years, BMI ≥30 kg/m², ASA physical status >2, and preoperative hemoglobin <10 g/dL, yielded an area under the curve of 0.71. Patients with 2 or more risk factors had the highest risk of requiring intraoperative conversion (12.0%).
The study concluded that low preoperative hemoglobin emerges as a new risk factor for converting minimally invasive to open gynecologic oncology surgeries. Stratifying patients based on conversion risk could aid preoperative planning.
No funding was provided.
Source: https://pubmed.ncbi.nlm.nih.gov/38783693/
Nguyen KH, Joo H, Manuel S, et al. (2024). “Incorporating low haemoglobin into a risk prediction model for conversion in minimally invasive gynaecologic oncology surgeries.” J Obstet Gynaecol. 2024 Dec;44(1):2349960. doi: 10.1080/01443615.2024.2349960. Epub 2024 May 23. PMID: 38783693.
