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Laparoscopic cholecystectomy for acute cholecystitis: how do fever and leucocytosis relate to conversion and
S Halachmi1, N DiCastro, I Matter
1Department of Surgery, Bnai Zion Medical Center and the Faculty of Medicine, Technion, Israel Institute of Technology, Haifa.
Objective:
To find out whether fever and raised white cell count (WCC) are associated with conversion and complications of laparoscopic cholecystectomy in acute cholecystitis, and whether their presence could help in deciding the place of laparoscopic procedures.
Design:
Prospective study.
Setting:
Teaching hospital, Israel.
Subjects:
256 patients who were treated for clinical acute cholecystitis between January 1994 and November 1997.
Interventions:
Emergency laparoscopic cholecystectomy.
Main Outcome Measures:
Raised temperature and WCC; incidence of conversion and complications.
Results:
Raised temperature (>38 degrees C) was independently associated with advanced cholecystitis (p = 0.002, odds ratio [OR] 2.7) and a palpable gallbladder preoperatively (p = 0.02, OR 2.1). Total complications correlated with a temperature of >38 degrees C. Raised WCC (>15 x 10(9)/L) was independently associated with age >45 years (p = 0.02, OR 2.4), a palpable gallbladder preoperatively (p = 0.001, OR 2.9), and a raised temperature (>38 degrees C) (p < 0.0001, OR 6.2). Conversion was associated with a WCC >18 x 10(9)/L (p = 0.0, OR 3.2).
Conclusion:
A WCC of >18 x 10(9)/L may assist in predicting conversion, and fever of >38 degrees C may assist in predicting the development of complications.