BACKGROUND: Laparoscopic cholecystectomy (LC) accounts for more than 85% of cholecystectomies. Factors prompting open cholecystectomy (OC) or conversion from LC to OC (CONV) are not completely understood. METHODS: Prospectively collected data from the National Surgical Quality Improvement Program (NSQIP) were combined with administrative data to identify patients undergoing cholecystectomy from October 2005 to October 2008. Three cohorts were defined: LC, OC, and CONV. Using logistic hierarchical modeling, we identified predictors of the choice of OC and the decision to CONV. RESULTS: A total of 11,669 patients underwent cholecystectomy at 117 VA hospitals, including 9,530 LC (81.7%). While the rate of conversion from LC to OC remained stable over the study period (9.0% overall), the percentage of OC decreased from 11.5% in 2006 to 10.1% in 2007 and 8.9% in 2008 (P = .0002). Compared with LC, the OC cohort had more comorbidities (35 of 41 preoperative characteristics, all P <.05), a higher 30-day morbidity rate (18.7% vs 4.8%. P <.0001), and a higher 30-day mortality rate (2.4% vs .4%, P <.0001). American Society of Anesthesiologist (ASA) class, patient comorbidities (eg, ascites, bleeding disorders, pneumonia) and functional status predicted a choice of OC. Age, preoperative albumin, previous abdominal surgery and emergency status predicted OC and CONV (all P <.05). A higher hospital conversion rate was independently predictive of OC (odds ratio [1% rate increase]: 1.05 [1.02-1.07]; P = .0004). CONCLUSION: In the last 3 years, there has been a trend towards performing fewer OCs in VA hospitals. More patient comorbidities and higher hospital-level conversion rates are predictive of the choice to perform or convert to OC. Published by Elsevier Inc.
BACKGROUND: Laparoscopic cholecystectomy (LC) accounts for more than 85% of cholecystectomies. Factors prompting open cholecystectomy (OC) or conversion from LC to OC (CONV) are not completely understood. METHODS: Prospectively collected data from the National Surgical Quality Improvement Program (NSQIP) were combined with administrative data to identify patients undergoing cholecystectomy from October 2005 to October 2008. Three cohorts were defined: LC, OC, and CONV. Using logistic hierarchical modeling, we identified predictors of the choice of OC and the decision to CONV. RESULTS: A total of 11,669 patients underwent cholecystectomy at 117 VA hospitals, including 9,530 LC (81.7%). While the rate of conversion from LC to OC remained stable over the study period (9.0% overall), the percentage of OC decreased from 11.5% in 2006 to 10.1% in 2007 and 8.9% in 2008 (P = .0002). Compared with LC, the OC cohort had more comorbidities (35 of 41 preoperative characteristics, all P <.05), a higher 30-day morbidity rate (18.7% vs 4.8%. P <.0001), and a higher 30-day mortality rate (2.4% vs .4%, P <.0001). American Society of Anesthesiologist (ASA) class, patient comorbidities (eg, ascites, bleeding disorders, pneumonia) and functional status predicted a choice of OC. Age, preoperative albumin, previous abdominal surgery and emergency status predicted OC and CONV (all P <.05). A higher hospital conversion rate was independently predictive of OC (odds ratio [1% rate increase]: 1.05 [1.02-1.07]; P = .0004). CONCLUSION: In the last 3 years, there has been a trend towards performing fewer OCs in VA hospitals. More patient comorbidities and higher hospital-level conversion rates are predictive of the choice to perform or convert to OC. Published by Elsevier Inc.
Authors: Torben Horn; Sara D Christensen; Jakob Kirkegård; Lars P Larsen; Anders R Knudsen; Frank V Mortensen Journal: HPB (Oxford) Date: 2014-11-14 Impact factor: 3.647
Authors: Balazs I Lengyel; Dan Azagury; Oliver Varban; Maria T Panizales; Jill Steinberg; David C Brooks; Stanley W Ashley; Ali Tavakkolizadeh Journal: Surg Endosc Date: 2011-09-23 Impact factor: 4.584
Authors: Kimberly G Blumenthal; Erin E Ryan; Yu Li; Hang Lee; James L Kuhlen; Erica S Shenoy Journal: Clin Infect Dis Date: 2018-01-18 Impact factor: 9.079
Authors: Ayman El Nakeeb; Youssef Mahdy; Aly Salem; Mohamed El Sorogy; Ahmed Abd El Rafea; Mohamed El Dosoky; Rami Said; Mohamed Abd Ellatif; Mohamed M A Alsayed Journal: Indian J Surg Date: 2017-03-22 Impact factor: 0.656
Authors: Natallia Kharytaniuk; Gary A Bass; Bogdan D Dumbrava; Paul P Healy; Dylan Viani-Walsh; Tej N Tiwary; Tahir Abassi; Matthew P Murphy; Emma Griffin; Thomas N Walsh Journal: Surg Endosc Date: 2019-11-25 Impact factor: 4.584