Steven J Coffin1, Sean M Wrenn2, Peter W Callas2, Wasef Abu-Jaish3,4. 1. The Robert Larner M.D. College of Medicine, The University of Vermont, 144 N Union St. Apt. 1, Burlington, VT, 05401, USA. Steven.coffin@med.uvm.edu. 2. Department of Surgery, University of Vermont Medical Center, 111 Colchester Ave, Mailstop 320FL4, Burlington, VT, 05401, USA. 3. The Robert Larner M.D. College of Medicine, The University of Vermont, 144 N Union St. Apt. 1, Burlington, VT, 05401, USA. Wasef.Abu-Jaish@uvmhealth.org. 4. Department of Surgery, University of Vermont Medical Center, 111 Colchester Ave, Mailstop 320FL4, Burlington, VT, 05401, USA. Wasef.Abu-Jaish@uvmhealth.org.
Abstract
INTRODUCTION: Recent data suggest a wide range of conversion (4.9-20%) from laparoscopic (LC) to open cholecystectomy (OC) despite increasing surgeon familiarity and superior equipment. Previously identified risk factors for conversion include increased age, male gender, diabetes, and emergent surgeries. Recent studies also suggest that formal minimally invasive surgical training (MIST) reduces conversion rates. We sought to determine conversion rates in our population, a rural academic medical center, and identify any significant risks for conversion. METHODS: We conducted a single-center retrospective review of 2810 cholecystectomies performed over a seven-year period (2009-2016). RESULTS: Our study included 837 (29.8%) males and 1973 (70.2%) females with a mean age of 49.2 years. Forty-two percent of cases were done by surgeons with MIST. A total of 139 (4.95%) cases were converted to OC. Univariate predictors of conversion to OC included male gender, age ≥65, urgent and emergent admissions, and MIST of the surgeon. In multivariate modeling, which included significant univariate predictors of conversion, independent predictors of conversion to OC included urgent or emergent admission, male gender, and age ≥65. MIST status was no longer a significant predictor. CONCLUSION: Our conversion rate from LC to OC falls within the lower range of recently published rates. This is likely multifactorial, and reflects increasing familiarity of the laparoscopic technique, improved quality of laparoscopic equipment, and/or prior knowledge of preoperative risk factors for conversion. Our results, consistent with previous literature, show a reduced conversion rate among surgeons with MIST. This finding, albeit not significant on multivariate analysis, may offer insight into a potential alterable preoperative risk factor for conversion and warrants further research. Further knowledge about the impact MIST has on conversion may provide a feasible preoperative approach to reducing conversion to OC, thereby reducing costs and overall patient morbidity.
INTRODUCTION: Recent data suggest a wide range of conversion (4.9-20%) from laparoscopic (LC) to open cholecystectomy (OC) despite increasing surgeon familiarity and superior equipment. Previously identified risk factors for conversion include increased age, male gender, diabetes, and emergent surgeries. Recent studies also suggest that formal minimally invasive surgical training (MIST) reduces conversion rates. We sought to determine conversion rates in our population, a rural academic medical center, and identify any significant risks for conversion. METHODS: We conducted a single-center retrospective review of 2810 cholecystectomies performed over a seven-year period (2009-2016). RESULTS: Our study included 837 (29.8%) males and 1973 (70.2%) females with a mean age of 49.2 years. Forty-two percent of cases were done by surgeons with MIST. A total of 139 (4.95%) cases were converted to OC. Univariate predictors of conversion to OC included male gender, age ≥65, urgent and emergent admissions, and MIST of the surgeon. In multivariate modeling, which included significant univariate predictors of conversion, independent predictors of conversion to OC included urgent or emergent admission, male gender, and age ≥65. MIST status was no longer a significant predictor. CONCLUSION: Our conversion rate from LC to OC falls within the lower range of recently published rates. This is likely multifactorial, and reflects increasing familiarity of the laparoscopic technique, improved quality of laparoscopic equipment, and/or prior knowledge of preoperative risk factors for conversion. Our results, consistent with previous literature, show a reduced conversion rate among surgeons with MIST. This finding, albeit not significant on multivariate analysis, may offer insight into a potential alterable preoperative risk factor for conversion and warrants further research. Further knowledge about the impact MIST has on conversion may provide a feasible preoperative approach to reducing conversion to OC, thereby reducing costs and overall patient morbidity.
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