Objective:To investigate the influencing factors of conversion to open surgery in patients with traumatic splenic rupture undergoing laparoscopic splenectomy and to construct a risk prediction model.Methods:Clinical data of 62 patients with traumatic splenic rupture admitted to The 909th Hospital from June 2019 to June 2022 were retrospectively analyzed.The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 47 patients were male and 15 female,aged from 29 to 51 years, with a median age of 41 years. 17 patients were diagnosed with grade Ⅱ splenic trauma, 35 cases of grade Ⅲ splenic trauma and 10 cases of grade Ⅳ splenic trauma. Intraoperative conversion to open surgery was performed in 14 patients. The influencing factors of intraoperative conversion to open surgery were analyzed by Chi-square test and multivariate Logistic regression analysis. The prediction model for risk of conversion to open surgery was constructed. The ROC curve was drawn to analyze the prediction efficiency of this model for the risk of conversion to open surgery.Results:Univariate analysis showed that the conversion rate in patients with BMI≥27 kg/m2, grade Ⅳ trauma, experienced attending physician as chief surgeon, intraoperative splenic injury and poor exposure was significantly increased (χ2=7.468, 15.336, 5.124, 15.849, 12.111; P<0.05). Multivariate analysis demonstrated that experienced chief surgeon, intraoperative splenic injury and poor exposure were the independent influencing factors for intraoperative conversion to open surgery (HR=17.717, 20.764, 10.343; P<0.05). Taking intraoperative conversion to open surgery as the dependent variable, and experienced chief surgeon, intraoperative splenic injury and poor exposure as the independent variables, the prediction model for risk of intraoperative conversion to open surgery was constructed as Logit(P)=-18.980+2.875×X1+3.033×X2+2.336×X3 (X1 was experienced chief surgeon, X2 was intraoperative splenic injury, X3 was poor exposure). The area under the ROC curve (AUC) of this prediction model was 0.925, the sensitivity was 0.857 and the specificity was 0.854.Conclusions:Insufficient experience of chief surgeon, intraoperative splenic injury and poor exposure are the independent influencing factors for the failure of laparoscopic surgery in patients with splenic rupture. Eligible patients for laparoscopic surgery can be screened by constructing risk prediction models.
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