Adil A Shah1, Umar F Bhatti2, Mikael Petrosyan3, George Washington1, Wasay Nizam1, Mallory Williams1, Daniel Tran1, Edward E Cornwell1, Terrence M Fullum4. 1. Department of Surgery, Howard University Hospital and College of Medicine, Washington, DC, USA. 2. Division of Acute Care Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, USA. 3. Department of Surgery, George Washington University and School of Medicine, Washington, DC, USA. 4. Department of Surgery, Howard University Hospital and College of Medicine, Washington, DC, USA. Electronic address: tfullum@howard.edu.
Abstract
BACKGROUND: Laparoscopic cholecystectomy (LC) is the standard operative intervention for gallbladder disease. Complications may necessitate conversion to an open cholecystectomy (OC). This study aims to determine the cost-consequences of laparoscopic-to-open conversion using a nationally-representative sample. METHODS: Using the National Inpatient Sample (2007-2011), adult patients undergoing emergent LC were identified. Patients undergoing secondary-conversion to OC were subsequently identified. Multivariable regression analyses, accounting for differences in propensity-quintile, mortality, length of stay, and hospital-level factors were then performed to assess for differences in the odds of conversion and total predicted mean costs per index-hospitalization. RESULTS: Of 225,805 observations, conversion to open occurred in 1.86% (n = 4203) of cases. Increased age, African-American ethnicity, public-insurance and teaching-hospital status were associated with a higher likelihood of conversion (p < 0.05) after risk-adjustment. Risk-adjusted odds of conversion increased by 34% (95%CI:1.33-1.36) for each day surgery was delayed. Risk-adjusted costs, were 259% higher (absolute-difference $23,358,p < 0.05) with conversion. Mortality was higher amongst patients undergoing conversion to open (4.98% vs 0.34%,p < 0.001). CONCLUSION: Patients undergoing conversion from laparoscopic to open cholecystectomy are at an increased risk of receiving disparate care and increased mortality.
BACKGROUND: Laparoscopic cholecystectomy (LC) is the standard operative intervention for gallbladder disease. Complications may necessitate conversion to an open cholecystectomy (OC). This study aims to determine the cost-consequences of laparoscopic-to-open conversion using a nationally-representative sample. METHODS: Using the National Inpatient Sample (2007-2011), adult patients undergoing emergent LC were identified. Patients undergoing secondary-conversion to OC were subsequently identified. Multivariable regression analyses, accounting for differences in propensity-quintile, mortality, length of stay, and hospital-level factors were then performed to assess for differences in the odds of conversion and total predicted mean costs per index-hospitalization. RESULTS: Of 225,805 observations, conversion to open occurred in 1.86% (n = 4203) of cases. Increased age, African-American ethnicity, public-insurance and teaching-hospital status were associated with a higher likelihood of conversion (p < 0.05) after risk-adjustment. Risk-adjusted odds of conversion increased by 34% (95%CI:1.33-1.36) for each day surgery was delayed. Risk-adjusted costs, were 259% higher (absolute-difference $23,358,p < 0.05) with conversion. Mortality was higher amongst patients undergoing conversion to open (4.98% vs 0.34%,p < 0.001). CONCLUSION:Patients undergoing conversion from laparoscopic to open cholecystectomy are at an increased risk of receiving disparate care and increased mortality.
Authors: Łukasz Warchałowski; Edyta Łuszczki; Anna Bartosiewicz; Katarzyna Dereń; Marta Warchałowska; Łukasz Oleksy; Artur Stolarczyk; Robert Podlasek Journal: Int J Environ Res Public Health Date: 2020-10-18 Impact factor: 3.390