Background
Previous studies evaluating predictive factors for conversion from laparoscopic to
open cholecystectomy have drawn conflicting conclusions. We evaluated objective preoperative
variables to create an accurate, accessible risk score to predict conversion.
Methods
A retrospective review was performed of laparoscopic cholecystectomy patients at an
urban tertiary care center. Seventy characteristics were subjected to bivariate and
multivariate logistic regression analysis to identify parameters that independently
predict conversion to open cholecystectomy. A model was created based on this analysis.
Results
Laparoscopic cholecystectomy was performed on 1377 patients for benign gallbladder
disease over a 71-month period. There were 112 (8.1%) conversions to open cholecystectomy.
The correlation between the preoperative clinical diagnosis and pathologic diagnosis
for acute and chronic cholecystitis was 48.6% and 94.6%, respectively. Multivariate
analysis identified male gender, elevated white blood cell count, low serum albumin,
ultrasound finding of pericholecystic fluid, diabetes mellitus, and elevated total
bilirubin as independent predictors of conversion. These 6 factors were also associated
with the pathologic diagnosis of acute cholecystitis. A model to calculate the risk
for conversion was created with an area under the receiver operator curve of 0.83.
The risk for conversion also can be estimated based on the number of factors identified
present and ranged from 2% when 1 factor was present to 89% with 6 factors.
Conclusions
These results demonstrate that conversion to open cholecystectomy can be predicted
based on parameters available preoperatively. Conversion is more likely in patients
who have acute cholecystitis; however, the correlation between its clinical and pathologic
diagnosis is poor. Improvements in the ability to determine the risk for conversion
have important implications for surgical care.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- A nationwide study of conversion from laparoscopic to open cholecystectomy.Am J Surg. 2004; 188: 205-211
- Predictive factors for conversion of laparoscopic cholecystectomy.World J Surg. 1997; 21: 629-633
- Factors determining conversion to laparotomy in patients undergoing laparoscopic cholecystectomy.Am J Surg. 1994; 167: 35-39
- A risk score for conversion from laparoscopic to open cholecystectomy.Am J Surg. 2001; 181: 520-525
- Conversions during laparoscopic cholecystectomy: risk factors and effects on patient outcome.J Gastrointest Surg. 2006; 10: 1081-1091
- Implementation of a scoring system for assessing difficult cholecystectomies in a single center.Surg Today. 2006; 36: 37-40
- Conversion of laparoscopic to open cholecystectomy.Surg Endosc. 1996; 10: 742-745
- Risk factors for conversion to open surgery in patients undergoing laparoscopic cholecystectomy.World J Surg. 2006; 30: 1698-1704
- Risk factors for conversion of laparoscopic cholecystectomy to open cholecystectomy.Surg Endosc. 2005; 19: 905-909
- Predictive factors for conversion of laparoscopic cholecystectomy.Am J Surg. 2002; 184: 254-258
- Complications of laparoscopic cholecystectomy in Switzerland.Surg Endosc. 1998; 12: 1303-1310
- Is male gender a risk factor for conversion of laparoscopic into open cholecystectomy?.Surg Endosc. 1996; 10: 892-894
- Predictive factors for the type of surgery in acute cholecystitis.Am J Surg. 2001; 182: 291-297
- Risk factors for conversion of laparoscopic to open cholecystectomy.J Surg Res. 2002; 106: 20-24
- Laparoscopic cholecystectomy for acute cholecystitis: can the need for conversion and the probability of complications be predicted?.Surg Endosc. 2000; 14: 755-760
- Laparoscopic cholecystectomy for acute cholecystitis: how do fever and leucocytosis relate to conversion and complications?.Eur J Surg. 2000; 166: 136-140
- A diagnostic score to predict the difficulty of a laparoscopic cholecystectomy from preoperative variables.Surg Endosc. 1998; 12: 148-150
- Laparoscopic cholecystectomy for symptomatic gallstones in diabetic patients.J Laparoendosc Adv Surg Tech A. 2001; 11: 281-284
- Acute cholecystitis in diabetic patients.Am Surg. 1995; 61: 964-967
- Early versus delayed-interval laparoscopic cholecystectomy for acute cholecystitis: a metaanalysis.Surg Endosc. 2006; 20: 82-87
- Mirizzi syndrome: laparoscopic management by subtotal cholecystectomy.Surg Endosc. 2006; 20: 1477-1481
- Influence of resident and attending surgeon seniority on operative performance in laparoscopic cholecystectomy.J Surg Res. 2006; 132: 159-163
- Teaching laparoscopic cholecystectomy: do beginners adversely affect the outcome of the operation?.Eur J Surg. 2002; 168: 470-474
- Mortality and complications associated with laparoscopic cholecystectomy.Ann Surg. 1996; 224: 609-620
- Laparoscopic cholecystectomy: early and late complications and their treatment.Langenbecks Arch Surg. 2004; 389: 164-171
Article info
Publication history
Accepted:
July 26,
2007
Identification
Copyright
© 2007 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
