Achieving consensus on the definition of conversion to laparotomy: a Delphi study among general surgeons, gynecologists, and urologists

Blikkendaal, Mathijs D.; Twijnstra, Andries R. H.; Stiggelbout, Anne M.; Beerlage, Harrie P.; Bemelman, Willem A.; Jansen, Frank Willem

doi:10.1007/s00464-013-3086-1

Cited by 41 publications

(24 citation statements)

References 27 publications

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“…Furthermore, recently robotic surgery has been introduced in the Netherlands, but this is not yet registered in the DSCA. As mentioned earlier, we were not able to use the exact definitions of the different types of conversion (strategic or reactive) as defined by Blikkendaal et al [22], because these were not incorporated in the DSCA dataset during this study period. Finally, the DSCA does not provide information on disease-free survival and overall (long-term) survival, which is an important topic for conversion.…”

Section: Discussionmentioning

confidence: 99%

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Laparoscopic conversion in colorectal cancer surgery; is there any improvement over time at a population level?

et al. 2018

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Conversion of laparoscopic colorectal cancer resection has been associated with worse outcome, but this might have been related to a learning curve effect. This study aimed to evaluate incidence, predictive factors and outcomes of laparoscopic conversion after the implementation phase of laparoscopic surgery at a population level. Patients undergoing elective resection of non-locally advanced, non-metastatic colorectal cancer between 2011 and 2015 were included. Data were extracted from the Dutch Surgical Colorectal Audit. Patients were grouped as laparoscopic completed (LR), laparoscopic converted (CONV) with further specification of timing (within or after 30 min) as registered in the DSCA, and open resection (OR). Uni- and multi-variate analyses were used to determine predictors of conversion and outcome (complicated course and mortality), with evaluation of trends over time. A total of 23,044 patients with colon cancer and 11,324 with rectal cancer were included. Between 2011 and 2015, use of laparoscopy increased from 55 to 84% in colon cancer, and from 49 to 89% in rectal cancer. Conversion rates decreased from 11.8 to 8.6% and from 13 to 8.0%, respectively. Laparoscopic hospital volume was independently associated with conversion rate. Only for colon cancer, the rate of complicated course was significantly higher after CONV compared to OR (adjusted odds ratio 1.486; 95% CI 1.298–1.702), and significantly higher after late (> 30 min) compared to early conversion (adjusted odds ratio 1.341; 1.046–1.719). There was no impact of CONV on mortality in both colon and rectal cancer. The use of laparoscopic colorectal cancer surgery increased to more than 80% at a national level, accompanied by a decrease in conversion which is significantly related to the laparoscopic hospital volume. Conversion was only associated with complicated course in colon cancer, especially when the reason for conversion consisted of an intra-operative complication, without affecting mortality.Electronic supplementary materialThe online version of this article (10.1007/s00464-018-6042-2) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

“…This is not according to the recently achieved international consensus about sub classifying conversion into strategic and reactive. [22] However, reasons for early or late conversion are registered, enabling to identify reactive conversions.…”

Section: Methodsmentioning

confidence: 99%

Laparoscopic conversion in colorectal cancer surgery; is there any improvement over time at a population level?

et al. 2018

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“…An RoA of more than 70% suggested consensus, in line with other medical Delphi studies (Supporting Information Figure S1). 11,12…”

Section: Discussionmentioning

confidence: 99%

Defining definitions: a Delphi study to develop a core outcome set for conditions of severe maternal morbidity

Schaap

Bloemenkamp

Deneux‐Tharaux

et al. 2017

BJOG

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“…Operative time was defined as the number of minutes between first incision and the final stitch. Complications were registered according to the classification of the Dutch Society of Obstetrics and Gynecology [8], including infection (local, organ, and systemic), injury (vascular, bowel, bladder, and ureter), wound dehiscence, hemorrhage (>1000 mL, postoperative bleeding), thromboembolism, dysfunction (urinary retention, incontinence, ileus, liver, kidney), systemic (medication error, adverse drug reaction), technical (failed procedure, corpus alienum), reactive conversions (as defined by Blikkendaal et al [9]), and other (not specified). The postsurgical follow-up period lasted for 6 weeks after discharge.…”

Section: Methodsmentioning

confidence: 99%

Identification of risk factors in minimally invasive surgery: a prospective multicenter study

et al. 2016

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BackgroundSince the introduction of minimally invasive surgery (MIS), concerns for patient safety are more often brought to the attention. Knowledge about and awareness of patient safety risk factors are crucial in order to improve and enhance the surgical team, the environment, and finally surgical performance. The aim of this study was to identify and quantify patient safety risk factors in laparoscopic hysterectomy and to determine their influence on surgical outcomes.MethodsA prospective multicenter study was conducted from April 2014 to January 2016, participating gynecologists registered their performed laparoscopic hysterectomies (LHs). If deemed necessary, gynecologists could fill out a checklist with validated patient safety risk factors. Association between procedures with and without an occurred risk factor(s) and the surgical outcomes (blood loss, operative time, and complications) were assessed, using multivariate logistic regression and generalized estimation equations.ResultsEighty-five gynecologists participated in the study, registering a total of 2237 LHs. For 627(28 %) procedures, the checklist was entered (in total 920 items). The most reported risk factors were related to the surgeon (19.6 %), the surgical team (14.4 %), technology (16.6 %), and the patient (26.8 %). The procedures where a risk factor was registered had significantly less favorable outcomes, higher complication rate (10.5 vs. 4.8 % (p = 0.002), longer operative time [114 vs. 95 min (p < 0.001)], and more blood loss [110 vs. 168 mL (p = 0.047)], which was mainly due to the technological and patient-related risk factors.ConclusionTechnological incidents are the most important and clinically relevant risk factors affecting surgical outcomes of LH. Future improvements of MIS need to focus on this. As awareness of safety risk factors in MIS is important, embedding of a safety risk factor checklist in registration systems will help surgeons to evaluate and improve their individual performance. This will inherently improve the surgical outcomes and thus patient safety.

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Achieving consensus on the definition of conversion to laparotomy: a Delphi study among general surgeons, gynecologists, and urologists

Cited by 41 publications

References 27 publications

Laparoscopic conversion in colorectal cancer surgery; is there any improvement over time at a population level?

Laparoscopic conversion in colorectal cancer surgery; is there any improvement over time at a population level?

Defining definitions: a Delphi study to develop a core outcome set for conditions of severe maternal morbidity

Identification of risk factors in minimally invasive surgery: a prospective multicenter study

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